title: Effect of alfacalcidol therapy on the survival of chronic hemodialysis patients.
abstract: The aim of this study was to determine the relationship between alfacalcidol therapy and the outcomes of chronic hemodialysis (HD) patients. We collected demographic and clinical baseline data from 190 prevalent HD patients in a regional Japanese cohort. A 5-year survival analysis was performed according to whether the patients were receiving calcitriol analog therapy. Alfacalcidol therapy at a mean dose of 5.2 ± 1.8 µg/week was performed in 89 (46.8%) of the 190 patients. We recorded 38 deaths during the follow-up period, including 19 deaths from cardiovascular events. A Kaplan-Meier analysis demonstrated that the alfacalcidol users had a significantly lower rate of all-cause mortality and cardiovascular mortality than the non-users. According to a multivariate Cox proportional hazards model, in addition to the use of alfacalcidol (HR=0.347 [0.155-0.714]; P = 0.0035), serum CRP levels (HR= 1.746 [1.184-2.442]; P = 0.0071) and non-HDL-cholesterol levels (HR=1.012 [1.001-1.022]; P = 0.0267) were identified as independent predictors of all-cause mortality, and the presence of diabetes mellitus (HR=3.720 [1.182-12.398]; P = 0.0246) was identified as an independent predictor of cardiovascular mortality. These findings suggest that low-dose alfacalcidol therapy provides a survival advantage to chronic HD patients.
authors.affiliation: Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Ogawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ogawa
authors.forename: Tomoko
authors.initials: T
authors.lastname: Inoue
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Otsuka
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use*; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D006887:Hydroxycholecalciferols; C008088:alfacalcidol