Association between vitamin D receptor activator and the risk of infection-related hospitalizations among incident hemodialysis patients: a nested case-control study.
BACKGROUND
Patients suffering from chronic kidney disease are at greater risk of developing infection than the normal population, and infections are the second cause of mortality after cardiovascular complications in this population. Some reports suggest that the intake of active vitamin D might be beneficial to prevent infections. Therefore, we aimed to determine if the oral intake of vitamin D receptor activator (VDRA) is associated with a lower risk of infection-related hospitalization (IRH) among incident chronic hemodialysis patients.


METHODS
We conducted a nested case-control study in a cohort of 4933 patients initiating chronic hemodialysis between 1 January 2001 and 31 December 2007 in Quebec, Canada, using administrative databases. We identified cases of hospital admission indicating an infection as main diagnosis on the hospital's discharge sheet. Up to 10 controls were randomly selected for each case. Association between oral VDRA use and risk of IRH was estimated using conditional logistic regression.


RESULTS
We identified 1136 cases of IRH and 10396 controls during the study period. The intake of VDRA was not associated with the risk of being hospitalized due to an infection (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.95-1.20). Using the prior 6-month cumulative dose of VDRA, we also found that a cumulative VDRA dose of less than 45 mcg (OR, 1.05; 95%CI, 0.92-1.19) or greater than 45 mcg (OR, 1.15; 95%CI, 0.96-1.36) was not associated with the IRH risk.


CONCLUSIONS
The oral intake of VDRA was not associated with the risk of IRH in incident hemodialysis patients.
Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada.
Isabelle
I
Normand
Naoual
N
Elftouh
Louis-Philippe
LP
Laurin
Denis
D
Ouimet
Hind
H
Harrak
Jean-Philippe
JP
Lafrance
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D002117:Calcitriol / Q000009:adverse effects / Q000494:pharmacology; D016022:Case-Control Studies; D015331:Cohort Studies; D003428:Cross Infection / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends; D006887:Hydroxycholecalciferols / Q000009:adverse effects / Q000494:pharmacology; D015994:Incidence; D018167:Receptors, Calcitriol / Q000819:agonists / Q000378:metabolism; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
C008088:alfacalcidol; D002117:Calcitriol; D006887:Hydroxycholecalciferols; D018167:Receptors, Calcitriol
epidemiology; infections; kidney failure, chronic; pharmacoepidemiology; registries; renal dialysis; vitamin D