title: Impact of hypovitaminosis D and alfacalcidol therapy on survival of hemodialysis patients: results from the French ARNOS study.
abstract: BACKGROUND
  In chronic kidney disease and dialysis patients, vitamin D deficiency is associated with mortality. In some observational studies, calcitriol analogue therapy was associated with a better survival rate in hemodialysis (HD) patients. The aim of this study was to determine the relationship between serum 25-hydroxyvitamin D (25-OHD) levels and alfacalcidol therapy with HD patients' outcomes.
  
  
  METHODS
  We measured baseline 25-OHD levels using a cross-sectional analysis in 648 HD prevalent patients from the regional ARNOS French cohort. A 42-month survival analysis was applied according to serum 25-OHD level and calcitriol analogue therapy.
  
  
  RESULTS
  The prevalence of 25-OHD insufficiency <30 ng/ml was high (73%), with only 22% taking native vitamin D supplementation. A baseline 25-OHD level above the median value (18 ng/ml) was associated with lower all-cause mortality [hazard ratio (HR), 0.73 (0.5-0.96); p = 0.02] after adjustment for age, gender, dialysis vintage, calcemia, phosphatemia, cardiovascular disease, and diabetes. Only in monovariate analysis was low-dose oral alfacalcidol therapy associated with a better survival rate in patients with and without 25-OHD deficiency [HR, 0.7 (0.5-0.92); p = 0.05].
  
  
  CONCLUSIONS
  Our study shows that, among prevalent HD patients, low 25-OHD levels affect mortality. Alfacalcidol therapy, especially in small doses, may provide compensation, but this needs to be further confirmed using prospective controlled studies comparing native and active vitamin D compounds.
authors.affiliation: Centre de Rein Artificiel, Service d'Hémodialyse, Tassin la Demi-Lune, France. guillaume-jean-crat@wanadoo.fr
authors.forename: G
authors.initials: G
authors.lastname: Jean
authors.forename: D
authors.initials: D
authors.lastname: Lataillade
authors.forename: L
authors.initials: L
authors.lastname: Genet
authors.forename: E
authors.initials: E
authors.lastname: Legrand
authors.forename: F
authors.initials: F
authors.lastname: Kuentz
authors.forename: X
authors.initials: X
authors.lastname: Moreau-Gaudry
authors.forename: D
authors.initials: D
authors.lastname: Fouque
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D014808:Vitamin D Deficiency / Q000188:drug therapy* / Q000401:mortality*
chemical_list: D006887:Hydroxycholecalciferols; C008088:alfacalcidol