title: Administration of alfacalcidol for patients with predialysis chronic kidney disease may reduce cardiovascular disease events.
abstract: BACKGROUND
  Besides its effect on calcium metabolism, vitamin D may play a part in preventing the onset and progression of cardiovascular disease (CVD) events. Only a few reports on the studies relating to whether vitamin D may reduce CVD events in patients with predialysis chronic kidney disease (CKD) are available, and many ambiguities remain.
  
  
  METHODS
  We conducted a retrospective cohort study of 665 patients with predialysis CKD. With log-rank test using the Kaplan-Meyer survival curve, comparison of incidences of CVD events, CVD-related mortality, and all-cause mortality were made between patients in the alfacalcidol treatment group (107 patients) in the predialysis stage to whom alfacalcidol 0.25-0.5 microg/day was orally administered for at least 24 weeks, and patients in the nontreatment group (558 patients) who received no administration of alfacalcidol or other type of activated vitamin D and its analogues. Patients to whom alfacalcidol administration was discontinued within 24 weeks as well as initiation of dialysis of <24 weeks were excluded for this study. Factors relating to CVD events were examined using Cox's proportional hazards analysis.
  
  
  RESULTS
  The mean follow-up period was 55.1 +/- 38.9 months in the alfacalcidol treatment group and 41.9 +/- 38.4 months in the nontreatment group. CVD events occurred in 172 patients during the follow-up period, and 74 of those occurred during the predialysis period. In the alfacalcidol treatment group, the incidence of cumulative CVD events was significantly lower. In relation to all-cause deaths and CVD-related deaths, the cumulative mortality rate was significantly lower in the alfacalcidol treatment group during the follow-up period. Throughout the follow-up period, the association between CVD events and alfacalcidol use was detected when adjusted for age, sex, diabetes, hypertension, use of renin-angiotensin system inhibitors, estimated glomerular filtration rate, and albumin and parathyroid hormone.
  
  
  CONCLUSIONS
  These data showed that oral administration of alfacalcidol for predialysis CKD patients was associated with reduced risk for CVD.
authors.affiliation: Department of Nephrology and Rheumatology, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Sugiura
authors.forename: Daijo
authors.initials: D
authors.lastname: Inaguma
authors.forename: Akimitsu
authors.initials: A
authors.lastname: Kitagawa
authors.forename: Minako
authors.initials: M
authors.lastname: Murata
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kamimura
authors.forename: Sho
authors.initials: S
authors.lastname: Sendo
authors.forename: Kyoko
authors.initials: K
authors.lastname: Hamaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagaya
authors.forename: Miho
authors.initials: M
authors.lastname: Tatematsu
authors.forename: Kei
authors.initials: K
authors.lastname: Kurata
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D006887:Hydroxycholecalciferols; C008088:alfacalcidol