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Performance Status Modifies the Association Between Vitamin D Receptor Activator and Mortality or Fracture: A Prospective Cohort Study on the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry |
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| Authors: | Miho Murashima Takayuki Hamano Takeshi Nishiyama Kazuhiko Tsuruya Satoshi Ogata Eiichiro Kanda Masanori Abe Ikuto Masakane Kosaku Nitta |
| Affiliation: | 1. Research Subcommittee of Japanese Renal Data Registry, Japanese Society for Dialysis Therapy, Nagoya, Japan;2. Department of Nephrology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan;3. Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Contribution: Conceptualization, Formal analysis, Supervision;4. Department of Nephrology, Nara Medical University, Kashihara, Japan Contribution: Supervision;5. Department of Clinical Nutrition, Hiroshima International University, Higashihiroshima, Japan Contribution: Supervision;6. Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Bunkyo-ku, Japan Medical Science, Kawasaki Medical School, Kurashiki, Japan Contribution: Supervision;7. Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Bunkyo-ku, Japan Division of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Itabashi, Japan Contribution: Supervision;8. Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Bunkyo-ku, Japan Department of Nephrology, Yabuki Hospital, Yamagata, Japan Contribution: Supervision;9. Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Bunkyo-ku, Japan Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan Contribution: Supervision |
| Abstract: | Immobilization osteoporosis is characterized by excess bone resorption. Vitamin D receptor activators (VDRA) might have adverse effects in immobilized patients. The objective of this study was to elucidate the impact of performance status (PS) on the associations between VDRA use and outcomes among hemodialysis patients. This is a prospective cohort study. Adults on hemodialysis in the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry were included. Exposure of interest was the use of VDRA. Outcomes were all-cause mortality and hip fracture. Associations between VDRA use and mortality or hip fractures were examined by Cox and Poisson regression analyses, respectively. Among 208,512 subjects, 128,535 were on VDRA. Poor PS was associated with higher calcium (Ca), lower parathyroid hormone, and higher alkaline phosphatase levels. The association between higher Ca levels and VDRA use was stronger among those with poor PS (p interaction 0.007). Adjusted hazard ratio (HR) (95% confidence interval [CI]) for mortality and incidence rate ratio (IRR) for hip fracture was 1.02 (95% CI, 0.99–1.05) and 0.93 (0.86–1.00) among users of VDRA, respectively. The VDRA use was associated with lower mortality and incidence of hip fractures among subjects with good PS but not among subjects with poor PS (p interaction 0.03 and 0.05). Effect modification by PS was observed for cardiovascular (CV) mortality but not for non-CV mortality. In conclusion, VDRA use was associated with better outcomes only among those with good PS. These results suggest that bone and mineral disorders among hemodialysis patients should be treated differently, depending on their performance status. © 2022 American Society for Bone and Mineral Research (ASBMR). |
| Keywords: | VITAMIN D RECEPTOR ACTIVATOR PERFORMANCE STATUS MORTALITY HIP FRACTURE CALCIUM ALKALINE PHOSPHATASE |