Intravenous vitamin D appears to significantly improve the survival of patients on dialysis

From: Roman Bystrianyk (rbystrianyk_at_gmail.com)
Date: 03/01/05 

Date: 28 Feb 2005 16:06:54 -0800

http://www.healthsentinel.com/news.php?event=news_print_list_item&id=648

"Intravenous vitamin D appears to significantly improve the survival of
patients on dialysis", news-medical.net, February 28, 2005,
Link: http://www.news-medical.net/?id=8049

The administration of intravenous vitamin D appears to significantly
improve the survival of patients on dialysis, according to a study that
will be published in the April Journal of the American Society of
Nephrology.

Vitamin D injections are currently recommended only for dialysis
patients with elevated levels of parathyroid hormone, but the report
from a Massachusetts General Hospital (MGH)-based research group
suggests that the treatment might help most dialysis patients live
longer.

"We've been administering vitamin D injections for decades, but the
potential benefit on survival has never been studied," says Ravi
Thadhani, MD, MPH, director of clinical research in MGH Nephrology, the
study's senior author. "This finding was a surprise and should force us
to think more broadly about who should be treated."

Among the approximately 300,000 U.S. patients who receive dialysis for
chronic kidney failure, the annual mortality rate is 20 percent, with
cardiovascular disease the primary cause of death. In healthy
individuals, the kidneys convert vitamin D from food and
over-the-counter supplements into an activated form that the body can
use. Kidney failure patient cannot utilize dietary vitamin D and must
receive activated forms of the nutrient to avoid deficiency. Currently
only 50 percent of kidney failure patients are treated with activated
vitamin D, since the therapy is recommended only for those who also
have elevated parathyroid levels.

In 2003 the same research group published a study finding that a
particular form of activated vitamin D, paricalcitol, was associated
with better survival than was calcitriol, previously the standard
activated vitamin D therapy. For the current study, the reseachers
asked the broader question of whether dialysis patients receiving any
form of activated vitamin D therapy would live longer than those who
did not.

Working with collaborators from Fresenius Medical Care North America,
based in Lexington, Mass., the researchers compiled information on more
than 50,000 patients who started dialysis at Fresenius centers across
the country between 1996 and 1999 and were followed into 2002. More
than 37,000 of those patients received injections of some form of
activated vitamin D.

At the end of the two-year study period, 76 percent of those receiving
any form of activated vitamin D were still alive, compared with 59
percent of those not receiving the therapy. That more than 20 percent
reduction in mortality was seen across all categories of patients in
the study - all races, ages and both genders. Even patients with
elevated calcium or phosphorus levels, which often lead to the
discontinuation of vitamin D therapy, lived longer if they received the
treatment.

These results must be confirmed by follow-up studies - including
randomized clinical trials - before more precise recommendations for
treatment can be made, but the researchers note that even many patients
who meet current guidelines for vitamin D therapy are not receiving it.

"While these results need to be verified, we at least need to be more
aggressive in treating people that meet the current criteria," Thadhani
says. "Thereafter we need to investigate what is the mechanism
conferring this survival benefit. We are actively pursuing that with a
focus on the effects on cardiovascular disease." Thadhani is an
assistant professor of Medicine at Harvard Medical School.

http://www.mgh.harvard.edu/

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