Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q-Cohort Study

Shigeru Tanaka; Toshiharu Ninomiya; Masatomo Taniguchi; Kiichiro Fujisaki; Masanori Tokumoto; Hideki Hirakata; Hiroaki Ooboshi; Takanari Kitazono; Kazuhiko Tsuruya

doi:10.1093/ndt/gfw205

Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q-Cohort Study

Shigeru Tanaka, Toshiharu Ninomiya, Masatomo Taniguchi, Kiichiro Fujisaki, Masanori Tokumoto, Hideki Hirakata, Hiroaki Ooboshi, Takanari Kitazono, Kazuhiko Tsuruya

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

BACKGROUND: Hemodialysis patients who receive vitamin D receptor activator (VDRA) reportedly have better survival after infection than those who do not. However, the optimal route of its administration for minimizing death from infection remains unclear.

METHODS: This prospective cohort study aimed to compare the effectiveness of oral versus intravenous VDRA regarding infection-related mortality in 3372 hemodialysis patients. Eligible subjects were divided into the following three groups by route of administration of VDRA: oral (n = 1868), intravenous (n = 492) and not administered (n = 1012). The effect of VDRA on infection-related mortality was examined using a Cox regression model with propensity score-based adjustments.

RESULTS: During follow-up (median, 4.0 years), 118 study patients died of infection. There was a significantly lower incidence of death from infection in subjects who received intravenous VDRA than in those who did not receive VDRA; however, oral VDRA did not significantly reduce the risk of mortality from infection compared with those who did not receive VDRA [hazard ratio (HR) for intravenous VDRA, 0.16; 95% confidence interval (CI), 0.10-0.25, and HR for oral VDRA, 0.78; 95% CI, 0.60-1.01]. Direct comparison between the oral and intravenous VDRA groups showed that the intravenous group had significantly better survival than the oral group (HR, 0.39; 95% CI, 0.27-0.62).

CONCLUSIONS: Treatment with intravenous VDRA more effectively reduces the incidence of mortality from infection than oral VDRA in hemodialysis patients.

Original language	English (US)
Pages (from-to)	1152-1160
Number of pages	9
Journal	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Volume	31
Issue number	7
DOIs	https://doi.org/10.1093/ndt/gfw205
State	Published - Jul 1 2016

Keywords

infection
mortality
propensity score
prospective cohort
vitamin D

ASJC Scopus subject areas

Nephrology
Transplantation

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Tanaka, S., Ninomiya, T., Taniguchi, M., Fujisaki, K., Tokumoto, M., Hirakata, H., Ooboshi, H., Kitazono, T., & Tsuruya, K. (2016). Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q-Cohort Study. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 31(7), 1152-1160. https://doi.org/10.1093/ndt/gfw205

Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients : the Q-Cohort Study. / Tanaka, Shigeru; Ninomiya, Toshiharu; Taniguchi, Masatomo; Fujisaki, Kiichiro; Tokumoto, Masanori; Hirakata, Hideki; Ooboshi, Hiroaki; Kitazono, Takanari; Tsuruya, Kazuhiko.

In: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Vol. 31, No. 7, 01.07.2016, p. 1152-1160.

Research output: Contribution to journal › Article › peer-review

Tanaka, S, Ninomiya, T, Taniguchi, M, Fujisaki, K, Tokumoto, M, Hirakata, H, Ooboshi, H, Kitazono, T & Tsuruya, K 2016, 'Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q-Cohort Study', Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, vol. 31, no. 7, pp. 1152-1160. https://doi.org/10.1093/ndt/gfw205

Tanaka S, Ninomiya T, Taniguchi M, Fujisaki K, Tokumoto M, Hirakata H et al. Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q-Cohort Study. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2016 Jul 1;31(7):1152-1160. https://doi.org/10.1093/ndt/gfw205

Tanaka, Shigeru ; Ninomiya, Toshiharu ; Taniguchi, Masatomo ; Fujisaki, Kiichiro ; Tokumoto, Masanori ; Hirakata, Hideki ; Ooboshi, Hiroaki ; Kitazono, Takanari ; Tsuruya, Kazuhiko. / Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients : the Q-Cohort Study. In: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2016 ; Vol. 31, No. 7. pp. 1152-1160.

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abstract = "BACKGROUND: Hemodialysis patients who receive vitamin D receptor activator (VDRA) reportedly have better survival after infection than those who do not. However, the optimal route of its administration for minimizing death from infection remains unclear.METHODS: This prospective cohort study aimed to compare the effectiveness of oral versus intravenous VDRA regarding infection-related mortality in 3372 hemodialysis patients. Eligible subjects were divided into the following three groups by route of administration of VDRA: oral (n = 1868), intravenous (n = 492) and not administered (n = 1012). The effect of VDRA on infection-related mortality was examined using a Cox regression model with propensity score-based adjustments.RESULTS: During follow-up (median, 4.0 years), 118 study patients died of infection. There was a significantly lower incidence of death from infection in subjects who received intravenous VDRA than in those who did not receive VDRA; however, oral VDRA did not significantly reduce the risk of mortality from infection compared with those who did not receive VDRA [hazard ratio (HR) for intravenous VDRA, 0.16; 95% confidence interval (CI), 0.10-0.25, and HR for oral VDRA, 0.78; 95% CI, 0.60-1.01]. Direct comparison between the oral and intravenous VDRA groups showed that the intravenous group had significantly better survival than the oral group (HR, 0.39; 95% CI, 0.27-0.62).CONCLUSIONS: Treatment with intravenous VDRA more effectively reduces the incidence of mortality from infection than oral VDRA in hemodialysis patients.",

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AU - Tokumoto, Masanori

AU - Hirakata, Hideki

AU - Ooboshi, Hiroaki

AU - Kitazono, Takanari

AU - Tsuruya, Kazuhiko

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N2 - BACKGROUND: Hemodialysis patients who receive vitamin D receptor activator (VDRA) reportedly have better survival after infection than those who do not. However, the optimal route of its administration for minimizing death from infection remains unclear.METHODS: This prospective cohort study aimed to compare the effectiveness of oral versus intravenous VDRA regarding infection-related mortality in 3372 hemodialysis patients. Eligible subjects were divided into the following three groups by route of administration of VDRA: oral (n = 1868), intravenous (n = 492) and not administered (n = 1012). The effect of VDRA on infection-related mortality was examined using a Cox regression model with propensity score-based adjustments.RESULTS: During follow-up (median, 4.0 years), 118 study patients died of infection. There was a significantly lower incidence of death from infection in subjects who received intravenous VDRA than in those who did not receive VDRA; however, oral VDRA did not significantly reduce the risk of mortality from infection compared with those who did not receive VDRA [hazard ratio (HR) for intravenous VDRA, 0.16; 95% confidence interval (CI), 0.10-0.25, and HR for oral VDRA, 0.78; 95% CI, 0.60-1.01]. Direct comparison between the oral and intravenous VDRA groups showed that the intravenous group had significantly better survival than the oral group (HR, 0.39; 95% CI, 0.27-0.62).CONCLUSIONS: Treatment with intravenous VDRA more effectively reduces the incidence of mortality from infection than oral VDRA in hemodialysis patients.

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Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q-Cohort Study

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