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Nephrol Dial Transplant (2004) 19: 179-184
© ERA–EDTA 2003; all rights reserved

Original Article

Lower risk for cardiovascular mortality in oral 1{alpha}-hydroxy vitamin D3 users in a haemodialysis population

Tetsuo Shoji1, Kayo Shinohara1, Eiji Kimoto1, Masanori Emoto1, Hideki Tahara1, Hidenori Koyama1, Masaaki Inaba1, Shinya Fukumoto1, Eiji Ishimura2, Takami Miki3, Tsutomu Tabata4 and Yoshiki Nishizawa1

1Department of Metabolism, Endocrinology and Molecular Medicine and 2Department of Nephrology, Osaka City University Graduate School of Medicine, 3Department of Geriatrics and Neurology, Osaka City University Medical School, Osaka and 4Division of Internal Medicine, Inoue Hospital, Suita, Japan

Correspondence and offprint requests to: Tetsuo Shoji, MD, PhD, Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. Email: t-shoji{at}med.osaka-cu.ac.jp

Background. Renal failure results in deficiency of active vitamin D3 that has diverse effects on metabolism and organ functions. Treatment with active forms of vitamin D3 ameliorates abnormalities in bone and mineral metabolism, cardiac function, immune response and others. We hypothesized that treatment with vitamin D3 may be beneficial for survival in patients with end-stage renal disease (ESRD).

Methods. We compared the risk of death between regular users (n = 162) and non-users (n = 80) of oral 1{alpha}-hydroxyvitamin D3 (alfacalcidol) in a cohort of ESRD patients undergoing haemodialysis for a follow-up of 61 ± 23 months. The daily dose of alfacalcidol ranged from 0.25 to 1.5 µg, with a median of 0.5 µg.

Results. The alfacalcidol users showed a lower risk of death from cardiovascular disease than the non-users in a univariate Cox model [hazards ratio (HR) 0.287, 95% confidence interval (CI) 0.127–0.649, P = 0.003], whereas the risk for death from non-cardiovascular disease was not different between the two groups. Stepwise multivariate Cox analysis showed that cardiovascular mortality was significantly associated with age, presence of diabetes mellitus and treatment with alfacalcidol (HR 0.377, 95% CI 0.246–0.578, P = 0.022).

Conclusions. These results indicate that use of oral alfacalcidol was associated with reduced risk for cardiovascular death in this cohort of ESRD patients. The result of this observational study warrants further randomized controlled trials with 1{alpha}-hydroxy vitamin D3 to confirm the possibility that such medication improves survival of ESRD patients.

Keywords: cardiovascular mortality; end-stage renal disease; haemodialysis; vitamin D3


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