ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO0573

Performance Status (PS) as an Effect Modifier for Association Between Vitamin D Receptor Activator (VDRA) and Outcomes Among Hemodialysis Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Murashima, Miho, Research Subcommittee of Japanese Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Hamano, Takayuki, Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Tsuruya, Kazuhiko, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan
  • Ogata, Satoshi, Hiroshima Kokusai Daigaku, Higashiiroshima, Hiroshima, Japan
  • Kanda, Eiichiro, Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Abe, Masanori, Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Masakane, Ikuto, Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Nitta, Kosaku, Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Tokyo, Japan
Background

VDRA use has been reported to be associated with lower mortality and fracture among hemodialysis patients. However, PS has not been considered in previous studies.

Methods

This is a prospective cohort study based on JSDT Renal Data Registry. Subjects on hemodialysis with age 20-100 at the end of 2009 were included. Exposure of interest was VDRA use. Outcome variables were two-year all-cause mortality and hip fracture. Associations between VDRA use and mortality or fracture were analyzed using Cox or poisson regression, respectively and interaction between VDRA use and PS was tested.

Results

Among 210,001 subjects, 80,492 (61.7%) were on VDRA. VDRA use was not associated with all-cause mortality (HR 1.02 [0.99-1.05]) or hip fracture (IRR 0.93 [0.86-1.00]) after adjustment for confounders including PS. The use of VDRA was associated with lower mortality and incidence of fracture among those with good PS (PS0) but not with poor PS (P interaction 0.03 and 0.05, respectively). Poor PS was associated with higher corrected calcium (Ca), lower parathyroid hormone (PTH) levels, and proportion of intravenous VDRA use was lower among those with poor PS. Linear regression analysis showed that the association between higher corrected Ca levels and VDRA use were stronger among those with poor PS compared with those with good PS (P interaction 0.01).

Conclusion

VDRA use was associated with better outcomes only among those with good PS. The reasons may be higher prevalence of adynamic bone among those with poor PS suggested by lower PTH levels and greater increase in Ca levels by VDRA, or preclusion of higher dose VDRA prescription due to higher Ca levels.