The use of activated vitamin D and risks of hospitalization for infection and amputation in incident hemodialysis patients in Taiwan: a nationwide population-based cohort study.
Aged
Amputation, Surgical
/ statistics & numerical data
Bone Density Conservation Agents
/ therapeutic use
Cohort Studies
Female
Hospitalization
/ statistics & numerical data
Humans
Infections
/ epidemiology
Ischemic Stroke
/ epidemiology
Kidney Failure, Chronic
/ therapy
Male
Middle Aged
Myocardial Infarction
/ epidemiology
Proportional Hazards Models
Renal Dialysis
Retrospective Studies
Risk Factors
Taiwan
/ epidemiology
Vitamin D
/ therapeutic use
Activated vitamin D
Acute myocardial infarction
Amputation
Competing risk analysis
Death
Hemodialysis
Infection
Ischemic stroke
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
06 08 2020
06 08 2020
Historique:
received:
24
10
2019
accepted:
29
07
2020
entrez:
9
8
2020
pubmed:
9
8
2020
medline:
21
10
2021
Statut:
epublish
Résumé
Hemodialysis patients have a high risk of mortality. The most common causes of death are cardiovascular disease and infection. The potential hazard or benefit associated with vitamin D use and cardiovascular or infection outcome is poorly characterized. We conducted a retrospective observational cohort study by recruiting 52,757 patients older than 20 years from Taiwan National Health Insurance Research Database (NHIRD) who initiated maintenance hemodialysis between 2001 and 2009. Patients who were prescribed activated vitamin D before the 360th day from hemodialysis initiation were defined as vitamin D users. The primary outcome of interest includes occurrence of acute myocardial infarction (AMI), ischemic stroke, lower limb amputation, and hospitalization for infection, respectively, while death events are treated as competing events. We conducted competing risk analysis using subdistribution hazard regression model to estimate subdistribution hazard ratios (SHRs) in relation to various outcomes. During the median follow-up of 1019 days, the vitamin D users had a lower crude mortality rate, lower incidences of AMI, ischemic stroke, amputation, and hospitalization for infection compared with non-users. Taking into consideration competing events of death, vitamin D users were associated with a lower hazard of lower limb amputation (SHR 0.84 [95% CI, 0.74-0.96]) and hospitalization for infection (SHR 0.90 [95% CI, 0.87-0.94]), but not AMI or ischemic stroke, after adjustment for potential confounders. Subgroup analyses and dose response evaluation both showed a consistent association of activated vitamin D treatment with decreased risk of amputation and infection. The findings suggest that therapeutic activated vitamin D use in hemodialysis patients may be beneficial for decreasing infection events and amputation, of which the latter is a complication of peripheral vascular disease, rather than reducing major atherosclerotic cardiovascular events such as AMI or ischemic stroke.
Sections du résumé
BACKGROUND
Hemodialysis patients have a high risk of mortality. The most common causes of death are cardiovascular disease and infection. The potential hazard or benefit associated with vitamin D use and cardiovascular or infection outcome is poorly characterized.
METHODS
We conducted a retrospective observational cohort study by recruiting 52,757 patients older than 20 years from Taiwan National Health Insurance Research Database (NHIRD) who initiated maintenance hemodialysis between 2001 and 2009. Patients who were prescribed activated vitamin D before the 360th day from hemodialysis initiation were defined as vitamin D users. The primary outcome of interest includes occurrence of acute myocardial infarction (AMI), ischemic stroke, lower limb amputation, and hospitalization for infection, respectively, while death events are treated as competing events. We conducted competing risk analysis using subdistribution hazard regression model to estimate subdistribution hazard ratios (SHRs) in relation to various outcomes.
RESULTS
During the median follow-up of 1019 days, the vitamin D users had a lower crude mortality rate, lower incidences of AMI, ischemic stroke, amputation, and hospitalization for infection compared with non-users. Taking into consideration competing events of death, vitamin D users were associated with a lower hazard of lower limb amputation (SHR 0.84 [95% CI, 0.74-0.96]) and hospitalization for infection (SHR 0.90 [95% CI, 0.87-0.94]), but not AMI or ischemic stroke, after adjustment for potential confounders. Subgroup analyses and dose response evaluation both showed a consistent association of activated vitamin D treatment with decreased risk of amputation and infection.
CONCLUSION
The findings suggest that therapeutic activated vitamin D use in hemodialysis patients may be beneficial for decreasing infection events and amputation, of which the latter is a complication of peripheral vascular disease, rather than reducing major atherosclerotic cardiovascular events such as AMI or ischemic stroke.
Identifiants
pubmed: 32762673
doi: 10.1186/s12882-020-01988-2
pii: 10.1186/s12882-020-01988-2
pmc: PMC7409709
doi:
Substances chimiques
Bone Density Conservation Agents
0
Vitamin D
1406-16-2
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
331Subventions
Organisme : Ministry of Science and Technology, Taiwan
ID : MOST 104-2321-B-006-036
Pays : International
Références
Kidney Int. 2015 Jan;87(1):195-9
pubmed: 24869671
Nephrol Dial Transplant. 2003 Sep;18(9):1731-40
pubmed: 12937218
J Am Soc Nephrol. 2007 Feb;18(2):613-20
pubmed: 17202417
J Vasc Surg. 2011 Mar;53(3):676-83
pubmed: 21211928
Clin Endocrinol (Oxf). 2012 Mar;76(3):315-25
pubmed: 21995874
Kidney Int Suppl. 2009 Aug;(113):S1-130
pubmed: 19644521
Clin J Am Soc Nephrol. 2008 Nov;3(6):1599-605
pubmed: 18815240
Am J Kidney Dis. 2011 Oct;58(4):536-43
pubmed: 21816525
Circulation. 2016 Feb 9;133(6):601-9
pubmed: 26858290
Pharmacoepidemiol Drug Saf. 2014 Mar;23(3):261-7
pubmed: 24470433
Clin Cancer Res. 2012 Apr 15;18(8):2301-8
pubmed: 22282466
Nephrol Dial Transplant. 2011 Jul;26(7):2250-6
pubmed: 20956810
PLoS One. 2014 Feb 26;9(2):e90201
pubmed: 24587279
Arch Intern Med. 2008 Aug 11;168(15):1629-37
pubmed: 18695076
Stat Med. 2016 Nov 20;35(26):4824-4836
pubmed: 27350312
Arch Intern Med. 2008 Feb 25;168(4):397-403
pubmed: 18299495
Clin J Am Soc Nephrol. 2012 Feb;7(2):358-65
pubmed: 22193236
Am J Nephrol. 2013;37(3):239-48
pubmed: 23467111
Stat Med. 2017 Nov 30;36(27):4391-4400
pubmed: 28913837
BMC Nephrol. 2018 Nov 6;19(1):309
pubmed: 30400889
Clin J Am Soc Nephrol. 2008 Sep;3(5):1487-93
pubmed: 18650409
Kidney Int. 2007 Oct;72(8):1004-13
pubmed: 17687259
Clin J Am Soc Nephrol. 2009 Jun;4(6):1128-35
pubmed: 19443628
Kidney Int Suppl. 1999 Jul;71:S130-3
pubmed: 10412756
JAMA Intern Med. 2018 Aug 1;178(8):1025-1032
pubmed: 29987332
Clin Infect Dis. 2004 Dec 15;39(12):1747-53
pubmed: 15578394
Am J Epidemiol. 2009 Jul 15;170(2):244-56
pubmed: 19494242
Sci Rep. 2017 Jan 31;7:41170
pubmed: 28139665
Diabetes Care. 2019 Aug;42(8):1430-1435
pubmed: 31142496
Clin J Am Soc Nephrol. 2011 Jun;6(6):1361-7
pubmed: 21617088
Pharmacoepidemiol Drug Saf. 2007 Mar;16(3):241-9
pubmed: 17252614
Rev Endocr Metab Disord. 2012 Mar;13(1):21-9
pubmed: 21845364
BMC Infect Dis. 2015 Oct 28;15:487
pubmed: 26521023
J Am Soc Nephrol. 2004 Apr;15(4):1038-45
pubmed: 15034107
Clin Exp Nephrol. 2015 Jun;19(3):371-8
pubmed: 24916005
J Clin Epidemiol. 2001 Apr;54(4):343-9
pubmed: 11297884