2008 JASN IMPACT FACTOR 7.505	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text (Rapid PDF) All Versions of this Article: ASN.2007091002v1 19/7/1379    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wolf, M. Articles by Thadhani, R. Search for Related Content PubMed PubMed Citation Articles by Wolf, M. Articles by Thadhani, R. Related Collections Related Article

Received September 12, 2007
Accepted on January 8, 2008

CLINICAL EPIDEMIOLOGY

Impact of Activated Vitamin D and Race on Survival among Hemodialysis Patients

Myles Wolf ^*, Joseph Betancourt , Yuchiao Chang , Anand Shah ^*, Ming Teng ^*, Hector Tamez ^*, Orlando Gutierrez ^*, Carlos A. Camargo Jr. , Michal Melamed , Keith Norris ^||, Meir J. Stampfer ^¶, Neil R. Powe ^**, and Ravi Thadhani ^*1

*Renal Unit and General Medicine Division, Department of Medicine, and Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, New York, New York; ||Charles R. Drew University of Medicine and Science, Los Angeles, California; ¶Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School and Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Massachusetts; and **Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Schools of Medicine and Public Health, Baltimore, Maryland

¹ To whom correspondence should be addressed. E-mail: rthadhani{at}partners.org.

	Abstract

Contrary to most examples of disparities in health outcomes, black patients have improved survival compared with white patients after initiating hemodialysis. Understanding potential explanations for this observation may have important clinical implications for minorities in general. This study tested the hypothesis that greater use of activated vitamin D therapy accounts for the survival advantage observed in black and Hispanic patients on hemodialysis. In a prospective cohort of non-Hispanic white (n = 5110), Hispanic white (n = 979), and black (n = 3214) incident hemodialysis patients, higher parathyroid hormone levels at baseline were the primary determinant of prescribing activated vitamin D therapy. Median parathyroid hormone was highest among black patients, who were most likely to receive activated vitamin D and at the highest dosage. One-year mortality was lower in black and Hispanic patients compared with white patients (16 and 16 versus 23%; P < 0.01), but there was significant interaction between race and ethnicity, activated vitamin D therapy, and survival. In multivariable analyses of patients treated with activated vitamin D, black patients had 16% lower mortality compared with white patients, but the difference was lost when adjusted for vitamin D dosage. In contrast, untreated black patients had 35% higher mortality compared with untreated white patients, an association that persisted in several sensitivity analyses. In conclusion, therapy with activated vitamin D may be one potential explanation for the racial differences in survival among hemodialysis patients. Further studies should determine whether treatment differences based on biologic differences contribute to disparities in other conditions.

This article has been cited by other articles:

				R. Thadhani Is Calcitriol Life-Protective for Patients with Chronic Kidney Disease? J. Am. Soc. Nephrol., November 1, 2009; 20(11): 2285 - 2290. [Full Text] [PDF]

				K. Kalantar-Zadeh and C. P. Kovesdy Clinical Outcomes with Active versus Nutritional Vitamin D Compounds in Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., September 1, 2009; 4(9): 1529 - 1539. [Abstract] [Full Text] [PDF]

				J. N. Artaza, R. Mehrotra, and K. C. Norris Vitamin D and the Cardiovascular System Clin. J. Am. Soc. Nephrol., September 1, 2009; 4(9): 1515 - 1522. [Abstract] [Full Text] [PDF]

				P.-S. Lee, K. Sampath, S. A. Karumanchi, H. Tamez, I. Bhan, T. Isakova, O. M. Gutierrez, M. Wolf, Y. Chang, T. P. Stossel, et al. Plasma Gelsolin and Circulating Actin Correlate with Hemodialysis Mortality J. Am. Soc. Nephrol., May 1, 2009; 20(5): 1140 - 1148. [Abstract] [Full Text] [PDF]

				A. A. Ginde, M. C. Liu, and C. A. Camargo Jr Demographic Differences and Trends of Vitamin D Insufficiency in the US Population, 1988-2004 Arch Intern Med, March 23, 2009; 169(6): 626 - 632. [Abstract] [Full Text] [PDF]

				F. Tentori, J. M. Albert, E. W. Young, M. J. Blayney, B. M. Robinson, R. L. Pisoni, T. Akiba, R. N. Greenwood, N. Kimata, N. W. Levin, et al. The survival advantage for haemodialysis patients taking vitamin D is questioned: findings from the Dialysis Outcomes and Practice Patterns Study Nephrol. Dial. Transplant., March 1, 2009; 24(3): 963 - 972. [Abstract] [Full Text] [PDF]

				J. N Artaza and K. C Norris Vitamin D reduces the expression of collagen and key profibrotic factors by inducing an antifibrotic phenotype in mesenchymal multipotent cells J. Endocrinol., February 1, 2009; 200(2): 207 - 221. [Abstract] [Full Text] [PDF]

				O. M. Gutierrez, M. Mannstadt, T. Isakova, J. A. Rauh-Hain, H. Tamez, A. Shah, K. Smith, H. Lee, R. Thadhani, H. Juppner, et al. Fibroblast Growth Factor 23 and Mortality among Patients Undergoing Hemodialysis N. Engl. J. Med., August 7, 2008; 359(6): 584 - 592. [Abstract] [Full Text] [PDF]

				K. Norris and A. R. Nissenson Race, Gender, and Socioeconomic Disparities in CKD in the United States J. Am. Soc. Nephrol., July 1, 2008; 19(7): 1261 - 1270. [Abstract] [Full Text] [PDF]

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673