BACKGROUND: Limited well-controlled research exists examining the impact of different formulations of oral vitamin D on clinical outcomes in dialysis patients, specifically those on peritoneal dialysis. For this retrospective mortality analysis, we compared mortality rates of patients on 3 of the most commonly prescribed vitamin D agents. METHODS: We examined 2 years (7/1/2008 to 6/30/2010) of oral medication records of peritoneal dialysis patients from a large US dialysis organization. Patients were identified whose physicians prescribed a single form of vitamin D (calcitriol, paricalcitol, or doxercalciferol) for ≥ 90% of all patient-months. We excluded incident patients (< 90 days on dialysis) and patients whose physicians treated < 5 peritoneal dialysis patients at a dialysis facility, and we assessed mortality. RESULTS: The analysis inclusion criteria identified 1,707 patients. The subset in this analysis included 12.6% of all prevalent peritoneal dialysis patients and 11.8% of prevalent patient-months. Patients with physicians who predominately prescribed calcitriol had a lower mortality rate: 9.33 (confidence interval (CI) 7.06, 11.60) deaths per 100 patient-years than the doxercalciferol, 12.20 (CI 9.34, 15.06) or paricalcitol, 12.27 (CI 9.27, 15.28) groups. However, these differences were not statistically significant. A Cox proportional hazards model, adjusting for differences in age, vintage, gender, race, body mass index, and comorbidities also showed no significant differences. CONCLUSIONS: For this peritoneal dialysis population, instrumental variable analyses showed no significant difference in mortality in patients taking the most common oral vitamin D formulations (calcitriol, doxercalciferol, paricalcitol).
BACKGROUND: Limited well-controlled research exists examining the impact of different formulations of oral vitamin D on clinical outcomes in dialysis patients, specifically those on peritoneal dialysis. For this retrospective mortality analysis, we compared mortality rates of patients on 3 of the most commonly prescribed vitamin D agents. METHODS: We examined 2 years (7/1/2008 to 6/30/2010) of oral medication records of peritoneal dialysis patients from a large US dialysis organization. Patients were identified whose physicians prescribed a single form of vitamin D (calcitriol, paricalcitol, or doxercalciferol) for ≥ 90% of all patient-months. We excluded incident patients (< 90 days on dialysis) and patients whose physicians treated < 5 peritoneal dialysis patients at a dialysis facility, and we assessed mortality. RESULTS: The analysis inclusion criteria identified 1,707 patients. The subset in this analysis included 12.6% of all prevalent peritoneal dialysis patients and 11.8% of prevalent patient-months. Patients with physicians who predominately prescribed calcitriol had a lower mortality rate: 9.33 (confidence interval (CI) 7.06, 11.60) deaths per 100 patient-years than the doxercalciferol, 12.20 (CI 9.34, 15.06) or paricalcitol, 12.27 (CI 9.27, 15.28) groups. However, these differences were not statistically significant. A Cox proportional hazards model, adjusting for differences in age, vintage, gender, race, body mass index, and comorbidities also showed no significant differences. CONCLUSIONS: For this peritoneal dialysis population, instrumental variable analyses showed no significant difference in mortality in patients taking the most common oral vitamin D formulations (calcitriol, doxercalciferol, paricalcitol).
Authors: Ditte Hansen; Knud Rasmussen; Henning Danielsen; Helmut Meyer-Hofmann; Egidijus Bacevicius; Thomas G Lauridsen; Jens K Madsen; Birgitte G Tougaard; Peter Marckmann; Peter Thye-Roenn; Jørgen E Nielsen; Svend Kreiner; Lisbet Brandi Journal: Kidney Int Date: 2011-08-10 Impact factor: 10.612
Authors: W G Goodman; J Goldin; B D Kuizon; C Yoon; B Gales; D Sider; Y Wang; J Chung; A Emerick; L Greaser; R M Elashoff; I B Salusky Journal: N Engl J Med Date: 2000-05-18 Impact factor: 91.245
Authors: Jack W Coburn; Hla M Maung; Logan Elangovan; Michael J Germain; Jill S Lindberg; Stuart M Sprague; Mark E Williams; Charles W Bishop Journal: Am J Kidney Dis Date: 2004-05 Impact factor: 8.860
Authors: Ming Teng; Myles Wolf; Edmund Lowrie; Norma Ofsthun; J Michael Lazarus; Ravi Thadhani Journal: N Engl J Med Date: 2003-07-31 Impact factor: 91.245
Authors: Ravi I Thadhani; Sophia Rosen; Norma J Ofsthun; Len A Usvyat; Lorien S Dalrymple; Franklin W Maddux; Jeffrey L Hymes Journal: Clin J Am Soc Nephrol Date: 2020-02-28 Impact factor: 8.237