The administration of intravenous vitamin D appears to significantly improve the survival of patients on dialysis, according to a study that will be published in the April Journal of the American Society of Nephrology.
Vitamin D injections are currently recommended only for dialysis patients with elevated levels of parathyroid hormone, but the report from a Massachusetts General Hospital (MGH)-based research group suggests that the treatment might help most dialysis patients live longer.
"We've been administering vitamin D injections for decades, but the potential benefit on survival has never been studied," says Ravi Thadhani, MD, MPH, director of clinical research in MGH Nephrology, the study's senior author. "This finding was a surprise and should force us to think more broadly about who should be treated."
Among the approximately 300,000 U.S. patients who receive dialysis for chronic kidney failure, the annual mortality rate is 20 percent, with cardiovascular disease the primary cause of death. In healthy individuals, the kidneys convert vitamin D from food and over-the-counter supplements into an activated form that the body can use. Kidney failure patient cannot utilize dietary vitamin D and must receive activated forms of the nutrient to avoid deficiency. Currently only 50 percent of kidney failure patients are treated with activated vitamin D, since the therapy is recommended only for those who also have elevated parathyroid levels.
In 2003 the same research group published a study finding that a particular form of activated vitamin D, paricalcitol, was associated with better survival than was calcitriol, previously the standard activated vitamin D therapy. For the current study, the reseachers asked the broader question of whether dialysis patients receiving any form of activated vitamin D therapy would live longer than those who did not.
Working with collaborators from Fresenius Medical Care North America, based in Lexington, Mass., the researchers compiled information on more than 50,000 patients who started dialysis at Fresenius centers across the country between 1996 and 1999 and were followed into 2002. More than 37,000 of those patients received injections of some form of activated vitamin D.