Vitamin D linked to reduced mortality rate in CKD

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Public release date: 7-May-2008

http://www.eurekalert.org/pub_releases/2008-05/ason-vdl050608.php

Contact: Shari Leventhal

sleventhal@...

American Society of Nephrology

Vitamin D linked to reduced mortality rate in CKD

Washington, DC (Tuesday, May 6, 2008) — For patients with moderate to

severe chronic kidney disease (CKD), treatment with activated vitamin D

may reduce the risk of death by approximately one-fourth, suggests a

study in the August Journal of the American Society of Nephrology.

Many patients with advanced CKD take the drug calcitriol, an oral form

of activated vitamin D, to treat elevated levels of parathyroid hormone.

" Although activated vitamin D is known to influence many biological

processes, previous clinical knowledge is limited to its effect on

parathyroid hormone levels, " explains Dr. Kestenbaum of the

University of Washington in Seattle, one of the study authors.

The study included 1,418 patients who had stage 3 to 4 CKD, which means

moderately to severely reduced kidney function. All patients also had

high parathyroid hormone levels (hyperparathyroidism), which can

contribute to weakening of the bones in CKD. The researchers identified

one group of patients who were being treated with calcitriol to lower

their parathyroid hormone levels and another group who were not

receiving calcitriol.

During a two-year follow-up period, mortality rates were compared for

patients who were and were not taking calcitriol. " We then adjusted for

differences in age, kidney function, parathyroid hormone levels, other

illnesses, and other medications, " says Dr. Kestenbaum.

In the adjusted analysis, the overall risk of death was about 26 percent

lower for patients taking calcitriol. Patients on calcitriol were also

less likely to develop end-stage renal disease, requiring dialysis to

replace lost kidney function.

Overall, treatment with calcitriol was associated with a 20 percent

reduction in the risk of either death or dialysis. The reduction in

mortality with calcitriol was unrelated to its effect on parathyroid

hormone levels.

" Recently, there has been an increased focus on the effects of vitamin D

beyond those on bone health, " Dr. Kestenbaum comments. " Vitamin D

deficiency has been associated with risk factors for cardiovascular

disease, such as high blood pressure, diabetes, and inflammation. "

Previous studies have suggested that treatment with intravenous vitamin

D can improve survival in patients on hemodialysis.

The new results suggest that treatment with oral activated vitamin D may

also improve survival in patients with CKD who do not yet require

dialysis. " Randomized clinical trials are needed to test the hypothesis

that vitamin D therapy can improve cardiovascular health and survival in

CKD, " Dr. Kestenbaum adds. " Future studies should also examine the role

of non-activated vitamin D, which is less expensive and less toxic. "

The study has some important limitations, including a lack of data on

other factors that may have affected survival in patients taking

calcitriol. Also, since the study included mainly older, white men, the

results may not apply to younger, more ethnically diverse populations

with CKD.

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This study was supported by a Career Development Award (K23 DK63274-01)

from the National Institutes of Health.

Dr. Kestenbaum receives consulting fees from Abbott and Shire as well as

grant support from Amgen.

The study entitled, " Association of Oral Calcitriol with Improved

Survival in Nondialyzed CKD, " will be available online at

http://jasn.asnjournals.org/ beginning on Wednesday, May 7, 2008, and in

print in the August issue of the Journal of the American Society of

Nephrology (JASN).

The American Society of Nephrology (ASN) is a not-for-profit

organization of 11,000 physicians and scientists dedicated to the study

of nephrology and committed to providing a forum for the promulgation of

information regarding the latest research and clinical findings on

kidney diseases. ASN publishes JASN, the Clinical Journal of the

American Society of Nephrology (CJASN), and the Nephrology

Self-Assessment Program (NephSAP). In January 2009, ASN will launch a

newsmagazine.

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

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