Ratio of paricalcitol dosage to serum parathyroid hormone level and survival in maintenance hemodialysis patients

Christian S. Shinaberger, Joel D. Kopple, Csaba Kovesdy, Charles J. McAllister, David van Wyck, Sander Greenland, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background and objectives: Several observational studies have indicated that vitamin D receptor activators (VDRA), including paricalcitol, are associated with greater survival in maintenance hemodialysis (MHD) patients; however, patients with higher serum parathyroid hormone (PTH), indicative of a more severe secondary hyperparathyroidism and higher death risk, are usually given higher VDRA dosages, which can lead to confounding by medical indication and attenuated survival advantage of high VDRA dosages. It was hypothesized that the ratio of the administered paricalcitol dosage to serum PTH level discloses better the underlying dosage-survival association. Design, setting, participants, & measurements: The 3-yr mortality predictability of the administered paricalcitol during the first 3 mo of the cohort divided by averaged serum intact PTH during the same period was examined in 34,307 MHD patients from all DaVita dialysis clinics across the United States using Cox regression. Results: MHD patients were 60.8 ± 15.4 yr of age and included 47% women, 34% black patients, and 47% patients with diabetes. Initially, the ratio of paricalcitol (μg/wk) to PTH (pg/ml) was divided into four groups: 0 (reference), 1 to <30, 30 to <60, and >60 × 1013. Unadjusted, case mix-adjusted (demographics, comorbidity, and Kt/V), and malnutrition-inflammation complex syndrome-adjusted models, the death rate ratio for the paricalcitol/PTH index groups, were 0.99, 0.95, and 0.92. Restricted cubic splines analyses were consistent with a linear relation. Conclusions: Higher weekly paricalcitol dosage per each unit of serum PTH seems to have an incremental association with greater survival in MHD patients. The observed dosage-response phenomenon needs to be confirmed in clinical trials.

Original languageEnglish (US)
Pages (from-to)1769-1776
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume3
Issue number6
DOIs
StatePublished - Nov 1 2008

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Parathyroid Hormone
Renal Dialysis
Maintenance
Survival
Calcitriol Receptors
Serum
Secondary Hyperparathyroidism
Mortality
Diagnosis-Related Groups
paricalcitol
Malnutrition
Observational Studies
Comorbidity
Dialysis
Demography
Clinical Trials
Inflammation

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Ratio of paricalcitol dosage to serum parathyroid hormone level and survival in maintenance hemodialysis patients. / Shinaberger, Christian S.; Kopple, Joel D.; Kovesdy, Csaba; McAllister, Charles J.; van Wyck, David; Greenland, Sander; Kalantar-Zadeh, Kamyar.

In: Clinical Journal of the American Society of Nephrology, Vol. 3, No. 6, 01.11.2008, p. 1769-1776.

Research output: Contribution to journalArticle

Shinaberger, Christian S. ; Kopple, Joel D. ; Kovesdy, Csaba ; McAllister, Charles J. ; van Wyck, David ; Greenland, Sander ; Kalantar-Zadeh, Kamyar. / Ratio of paricalcitol dosage to serum parathyroid hormone level and survival in maintenance hemodialysis patients. In: Clinical Journal of the American Society of Nephrology. 2008 ; Vol. 3, No. 6. pp. 1769-1776.
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AU - Kopple, Joel D.

AU - Kovesdy, Csaba

AU - McAllister, Charles J.

AU - van Wyck, David

AU - Greenland, Sander

AU - Kalantar-Zadeh, Kamyar

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