title: Use of vitamin D receptor activator, incident cardiovascular disease and death in a cohort of hemodialysis patients.
abstract: The use of vitamin D receptor activators (VDRAs) is an independent predictor of a lower risk of death from cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). We examined whether the use of VDRAs and other CKD-mineral bone disorder (MBD)-related factors are associated with incident CVD or death after CVD in hemodialysis patients. This is a historical cohort study of 37 690 prevalent hemodialysis patients without previous history of CVD at the end of 2004 extracted from a nationwide registry in Japan. The key exposure was the use of VDRAs, and the outcomes were incident CVD (myocardial infarction, cerebral infarction, cerebral hemorrhage, and sudden death) and death after CVD during the 1-year follow-up. VDRAs were used in 57% of the subjects at baseline. We identified 2433 patients with incident CVD and 397 deaths after the events. In multivariate logistic regression models, independent predictors of incident CVD were non-use of VDRA, higher intact PTH, non-use of calcium-based phosphate-binder, and non-use of non-calcium-based phosphate binder. Risk of death after CVD was not significantly associated with VDRA, whereas it was lower in those with lower corrected calcium, and the risk was higher in those with higher phosphate and in non-users of calcium-based phosphate binders. The use of VDRAs was associated with a lower risk of incident CVD but not with death after CVD in this large cohort of hemodialysis patients. The CKD-MBD-related predictors of poor outcomes are associated with the risk of incident CVD, the risk of death after CVD, or both.
authors.affiliation: Department of Geriatrics and Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.|Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.affiliation: Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Marubayashi
authors.affiliation: Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shigematsu
authors.affiliation: Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.affiliation: Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D002614:Chelating Agents / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000378:metabolism; D018167:Receptors, Calcitriol / Q000187:drug effects* / Q000378:metabolism; D012042:Registries; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012307:Risk Factors
chemical_list: D002614:Chelating Agents; D010710:Phosphates; D018167:Receptors, Calcitriol
keywords: Chronic kidney disease mineral bone disorder; Fatality; Hemodialysis; Incident cardiovascular disease; Mortality; Phosphate binders; Vitamin D