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Association of Oral Calcitriol with Improved Survival in Nondialyzed CKD

Abigail B. Shoben^*, Kyle D. Rudser^*, Ian H. de Boer, Bessie Young and Bryan Kestenbaum

^* Department of Biostatistics, Division of Nephrology, Division of Nephrology, Puget Sound Veterans’ Affairs Medical Center, and Division of Nephrology, Harborview Medical Center, University of Washington, Seattle, Washington

Correspondence: Dr. Bryan Kestenbaum, University of Washington, Division of Nephrology, Harborview Medical Center, Room 10EH11, Box 359764, Seattle, WA 98104-2499. Phone: 206-731-4029; Fax: 206-731-2252; E-mail: brk{at}u.washington.edu

Received for publication November 1, 2007. Accepted for publication March 24, 2008.

Parenteral vitamin D is associated with improved survival among long-term hemodialysis patients. Among nondialyzed patients with chronic kidney disease (CKD), oral activated vitamin D reduces parathyroid hormone levels, but the impact on clinical outcomes is unknown. We evaluated associations of oral calcitriol use with mortality and dialysis dependence in 1418 nondialysis patients with CKD and hyperparathyroidism in the Veterans’ Affairs Consumer Health Information and Performance Sets database. Incident calcitriol users and nonusers were selected on the basis of stages 3 to 4 CKD, hyperparathyroidism, and the absence of hypercalcemia before calcitriol use and then were matched by age and estimated kidney function. During a median follow-up of 1.9 yr, 408 (29%) patients died and 217 (16%) initiated long-term dialysis. After adjustment for demographics; comorbidities; estimated kidney function; medications; and baseline levels of parathyroid hormone, calcium, and phosphorous, oral calcitriol use was associated with a 26% lower risk for death (95% confidence interval 5 to 42% lower; P = 0.016) and a 20% lower risk for death or dialysis (95% confidence interval 1 to 35% lower; P = 0.038). The association of calcitriol with improved survival was not statistically different across baseline parathyroid hormone levels. Calcitriol use was associated with a greater risk for hypercalcemia. In conclusion, oral calcitriol use is associated with lower mortality in nondialysis patients with CKD.

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