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Nitta Kosaku
Department Other, Other Position |
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| Article types | Original article |
| Language | English |
| Peer review | Non peer reviewed |
| Title | 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. |
| Journal | Formal name：Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research Abbreviation：J Bone Miner Res ISSN code：15234681/08840431 |
| Volume, Issue, Page | 37(8),pp.1489-1499 |
| Author and coauthor | Murashima Miho, Hamano Takayuki, Nishiyama Takeshi, Tsuruya Kazuhiko, Ogata Satoshi, Kanda Eiichiro, Abe Masanori, Masakane Ikuto, Nitta Kosaku |
| Authorship | Last author,Corresponding author |
| Publication date | 2022/08 |
| Summary | 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). |
| DOI | 10.1002/jbmr.4621 |
| PMID | 35689819 |