title: Vitamin D Receptor Activator Use and Cause-specific Death among dialysis Patients: a Nationwide Cohort Study using Coarsened Exact Matching.
abstract: Vitamin D receptor activators (VDRA) may exert pleiotropic effects on cardiovascular disease, malignancy, and infections among dialysis patients, but recent studies have mainly focused on cardiovascular outcomes. Among 8,675 patients who started dialysis in 2007 and who survived until January 1, 2010, listed in the Renal Data Registry of the Japanese Society for Dialysis Therapy, 5,365 VDRA users were matched to 3,203 non-users based on clinically relevant variables at the end of 2009 using the coarsened exact matching procedure. Until December 31, 2011, a total of 1,128 deaths occurred, of which 468 (42%) were cardiovascular deaths, 229 (20%) were infection-related deaths, and 141 (12%) were malignancy-related deaths. Multivariable survival analyses accounting for intra-region correlation revealed that VDRA use was significantly associated with lower rates of infection- and malignancy-related deaths [subhazard ratio 0.62 (95% CI, 0.52-0.73) and 0.70 (95% CI, 0.50-0.97), respectively] but not with cardiovascular death [subhazard ratio 0.86 (95% CI, 0.72-1.04)]. Future randomized clinical trials with a sufficient sample size and an adequate follow-up period are warranted to test the clinical effectiveness of VDRA on infection and malignancy, rather than cardiovascular disease, among dialysis patients.
authors.affiliation: Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Obi
authors.affiliation: Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.|Committee of Renal Data Registry of the Japanese Society for Dialysis Therapy, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hamano
authors.affiliation: Committee of Renal Data Registry of the Japanese Society for Dialysis Therapy, Bunkyo-ku, Tokyo 113-0033, Japan.|Department of Internal Medicine, Kita Saito Hospital, Asahikawa, Hokkaido 070-0030, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Wada
authors.affiliation: Committee of Renal Data Registry of the Japanese Society for Dialysis Therapy, Bunkyo-ku, Tokyo 113-0033, Japan.|Jikei Institute Graduate School of Health Care Sciences, Osaka, Osaka 532-0003, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D003141:Communicable Diseases / Q000209:etiology / Q000401:mortality*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D006435:Renal Dialysis / Q000379:methods*; D018401:Sample Size; D016019:Survival Analysis; D014807:Vitamin D / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D014807:Vitamin D