Assessing the effect of oral activated vitamin D on overall survival in hemodialysis patients: A landmark analysis 11 Medical and Health Sciences 1117 Public Health and Health Services

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Abstract

Background: Patients with end stage renal disease have a high all-cause and cardiovascular mortality. Secondary hyperparathyroidism and vitamin D deficiency are considered part of the mechanism for the excess mortality observed. We aimed to evaluate the relationship between vitamin D use and all-cause mortality. Methods: In this retrospective cohort study, we included all incident patients who started hemodialysis in Taiwan between 2001 and 2009. Patients were followed from landmark time, i.e., the 360th day from hemodialysis initiation, through the end of 2010 or death. We evaluated the association between activated vitamin D use or not before landmark time and all-cause mortality using conditional landmark analysis with Cox regression. We used group-based trajectory model to categorize high-dose versus average-dose users to evaluate dose-response relationships. Results: During the median follow-up of 1019 days from landmark time, vitamin D users had a lower crude mortality rate than non-users (8.98 versus 12.93 per 100 person-years). Compared with non-users, vitamin D users was associated with a lower risk of death in multivariate Cox model (HR 0.91 [95% CI, 0.87-0.95]) and after propensity score matching (HR 0.94 [95% CI, 0.90-0.98]). High-dose vitamin D users had a lower risk of death than conventional-dose users, HR 0.75 [95% CI, 0.63-0.89]. The association of vitamin D treatment with reduced mortality did not alter when we re-defined landmark time as the 180th day or repeated analyses in patients who underwent hemodialysis in the hospital setting. Conclusions: Our findings supported the survival benefits of activated vitamin D among incident hemodialysis patients.

Original languageEnglish
JournalBMC Nephrology
Volume19
Issue number1
DOIs
Publication statusPublished - 2018 Nov 6

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Vitamin D
Health Services
Renal Dialysis
Public Health
Survival
Health
Mortality
Propensity Score
Secondary Hyperparathyroidism
Vitamin D Deficiency
Taiwan
Proportional Hazards Models
Chronic Kidney Failure
Cohort Studies
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

@article{f56e30ea18944f11b2ef8b84d771f7c6,
title = "Assessing the effect of oral activated vitamin D on overall survival in hemodialysis patients: A landmark analysis 11 Medical and Health Sciences 1117 Public Health and Health Services",
abstract = "Background: Patients with end stage renal disease have a high all-cause and cardiovascular mortality. Secondary hyperparathyroidism and vitamin D deficiency are considered part of the mechanism for the excess mortality observed. We aimed to evaluate the relationship between vitamin D use and all-cause mortality. Methods: In this retrospective cohort study, we included all incident patients who started hemodialysis in Taiwan between 2001 and 2009. Patients were followed from landmark time, i.e., the 360th day from hemodialysis initiation, through the end of 2010 or death. We evaluated the association between activated vitamin D use or not before landmark time and all-cause mortality using conditional landmark analysis with Cox regression. We used group-based trajectory model to categorize high-dose versus average-dose users to evaluate dose-response relationships. Results: During the median follow-up of 1019 days from landmark time, vitamin D users had a lower crude mortality rate than non-users (8.98 versus 12.93 per 100 person-years). Compared with non-users, vitamin D users was associated with a lower risk of death in multivariate Cox model (HR 0.91 [95{\%} CI, 0.87-0.95]) and after propensity score matching (HR 0.94 [95{\%} CI, 0.90-0.98]). High-dose vitamin D users had a lower risk of death than conventional-dose users, HR 0.75 [95{\%} CI, 0.63-0.89]. The association of vitamin D treatment with reduced mortality did not alter when we re-defined landmark time as the 180th day or repeated analyses in patients who underwent hemodialysis in the hospital setting. Conclusions: Our findings supported the survival benefits of activated vitamin D among incident hemodialysis patients.",
author = "Jo-Yen Chao and Chien, {Hsu Chih} and Te-Hui Kuo and Yu-Tzu Chang and Chung-Yi Li and Ming-Cheng Wang and Yea-Huei Kao",
year = "2018",
month = "11",
day = "6",
doi = "10.1186/s12882-018-1111-2",
language = "English",
volume = "19",
journal = "BMC Nephrology",
issn = "1471-2369",
publisher = "BioMed Central",
number = "1",

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T1 - Assessing the effect of oral activated vitamin D on overall survival in hemodialysis patients

T2 - A landmark analysis 11 Medical and Health Sciences 1117 Public Health and Health Services

AU - Chao, Jo-Yen

AU - Chien, Hsu Chih

AU - Kuo, Te-Hui

AU - Chang, Yu-Tzu

AU - Li, Chung-Yi

AU - Wang, Ming-Cheng

AU - Kao, Yea-Huei

PY - 2018/11/6

Y1 - 2018/11/6

N2 - Background: Patients with end stage renal disease have a high all-cause and cardiovascular mortality. Secondary hyperparathyroidism and vitamin D deficiency are considered part of the mechanism for the excess mortality observed. We aimed to evaluate the relationship between vitamin D use and all-cause mortality. Methods: In this retrospective cohort study, we included all incident patients who started hemodialysis in Taiwan between 2001 and 2009. Patients were followed from landmark time, i.e., the 360th day from hemodialysis initiation, through the end of 2010 or death. We evaluated the association between activated vitamin D use or not before landmark time and all-cause mortality using conditional landmark analysis with Cox regression. We used group-based trajectory model to categorize high-dose versus average-dose users to evaluate dose-response relationships. Results: During the median follow-up of 1019 days from landmark time, vitamin D users had a lower crude mortality rate than non-users (8.98 versus 12.93 per 100 person-years). Compared with non-users, vitamin D users was associated with a lower risk of death in multivariate Cox model (HR 0.91 [95% CI, 0.87-0.95]) and after propensity score matching (HR 0.94 [95% CI, 0.90-0.98]). High-dose vitamin D users had a lower risk of death than conventional-dose users, HR 0.75 [95% CI, 0.63-0.89]. The association of vitamin D treatment with reduced mortality did not alter when we re-defined landmark time as the 180th day or repeated analyses in patients who underwent hemodialysis in the hospital setting. Conclusions: Our findings supported the survival benefits of activated vitamin D among incident hemodialysis patients.

AB - Background: Patients with end stage renal disease have a high all-cause and cardiovascular mortality. Secondary hyperparathyroidism and vitamin D deficiency are considered part of the mechanism for the excess mortality observed. We aimed to evaluate the relationship between vitamin D use and all-cause mortality. Methods: In this retrospective cohort study, we included all incident patients who started hemodialysis in Taiwan between 2001 and 2009. Patients were followed from landmark time, i.e., the 360th day from hemodialysis initiation, through the end of 2010 or death. We evaluated the association between activated vitamin D use or not before landmark time and all-cause mortality using conditional landmark analysis with Cox regression. We used group-based trajectory model to categorize high-dose versus average-dose users to evaluate dose-response relationships. Results: During the median follow-up of 1019 days from landmark time, vitamin D users had a lower crude mortality rate than non-users (8.98 versus 12.93 per 100 person-years). Compared with non-users, vitamin D users was associated with a lower risk of death in multivariate Cox model (HR 0.91 [95% CI, 0.87-0.95]) and after propensity score matching (HR 0.94 [95% CI, 0.90-0.98]). High-dose vitamin D users had a lower risk of death than conventional-dose users, HR 0.75 [95% CI, 0.63-0.89]. The association of vitamin D treatment with reduced mortality did not alter when we re-defined landmark time as the 180th day or repeated analyses in patients who underwent hemodialysis in the hospital setting. Conclusions: Our findings supported the survival benefits of activated vitamin D among incident hemodialysis patients.

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U2 - 10.1186/s12882-018-1111-2

DO - 10.1186/s12882-018-1111-2

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