title: The use of vitamin D analogs is independently associated with the favorable renal prognosis in chronic kidney disease stages 4-5: the CKD-ROUTE study.
abstract: BACKGROUND
  Vitamin D analogs have generally been recommended for treatment of mineral bone disease in chronic kidney disease (CKD). However, the association between this treatment and CKD progression has not yet been established.
  
  
  METHODS
  We designed a post hoc propensity score-matched cohort analysis derived from 3-year follow-up data of a prospective cohort. Adult participants with pre-dialysis CKD stages 4-5 who had newly been prescribed active vitamin D analogs during the observation period were eligible as matched cases. Then, matched controls were extracted from participants who had never been prescribed active vitamin D analogs. The primary outcome was a composite of end-stage renal disease or a 50 % reduction in estimated glomerular filtration rate (eGFR). A Cox proportional hazards model evaluated the association between the use of vitamin D analogs and the primary outcome.
  
  
  RESULTS
  We enrolled 240 patients (males, 65 %). The number of matched cases and controls was 30 and 210, respectively. The primary outcome was observed in 94 patients, whereas 25 patients died. The mean ± standard deviation age and eGFR were 69 ± 12 years and 17 ± 5.7 ml/min/1.73 m2, respectively. In a Cox proportional hazard model, the use of vitamin D analogs was independently associated with a lower risk of the primary outcome (crude hazard ratio 0.41; 95 % confidence interval 0.19, 0.89; adjusted hazard ratio 0.38; 95 % confidence interval 0.17, 0.88).
  
  
  CONCLUSIONS
  The use of vitamin D analogs is independently associated with the preservation of renal function in patients with pre-dialysis CKD stages 4-5.
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Arai
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan. tokyo.kyosai.kanda@gmail.com.|Department of Nephrology, Tokyo Kyosai Hospital, Tokyo, Japan. tokyo.kyosai.kanda@gmail.com.
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Kanda
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Iimori
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Naito
authors.affiliation: Department of Nephrology, Nitobe Memorial Nakano General Hospital, Tokyo, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Noda
authors.affiliation: Department of Nephrology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kawasaki
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Nephrology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Ando
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Sei
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Eisei
authors.initials: E
authors.lastname: Sohara
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Okado
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tatemitsu
authors.initials: T
authors.lastname: Rai
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007564:Japan; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*
chemical_list: D014807:Vitamin D
keywords: Chronic kidney disease; End-stage renal disease; Mineral bone disease; Vitamin D