Treatment Helps Dialysis Patients Live Longer

(Ivanhoe Newswire) -- Dialysis patients who receive a newer form of vitamin D to treat a common complication of kidney disease survive longer than those who receive the older, standard form, find researchers publishing in this week’s New England Journal of Medicine.

The study, led by Ravi Thadhani, M.D., M.P.H., from Massachusetts General Hospital, and conducted among about 67,000 dialysis patients being treated in centers across the country, noted a 16 percent higher survival rate for patients receiving paricalcitol to treat hyperparathyroidism than those receiving calcitriol.

Hyperparathyroidism arises from an imbalance in bone and mineral metabolism resulting from kidney failure. The disease is treated with intravenous injections of vitamin D, but vitamin D itself can increase the risk of mortality from heart disease by elevating calcium and phosphorus levels, which accelerate vascular disease. The newer form of vitamin D, which was approved by the Food and Drug Administration in 1998, helps to stabilize blood calcium and phosphorous levels, possibly lowering that risk. These researchers decided to see if the patients using the newer form had better survival rates as a result.

The study followed the patients for three years, analyzing outcomes for those who received the two different forms of vitamin D. About 29,000 started out receiving paricalcitol and 38,000 began with calcitriol, the standard form. Around 16,000 of the patients switched treatments during the study. In addition to the overall 16-percent increase in survival seen among those who stuck with paricalcitol, the research found an increase in survival among those who switched to the newer treatment during the study. Paricalcitol also increased survival rates among diabetics and African-Americans, two groups with higher-than-average death rates on dialysis.

Noting the high mortality rate for dialysis patients -- about 20 percent annually -- and the lack of effective treatments to lower that rate, Dr. Thadhani concludes, “This is the first evidence that a specific form of vitamin D can change the high rate of mortality among dialysis patients. If further research confirms our findings, this will be very important information for dialysis patients and their physicians.”

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

SOURCE: New England Journal of Medicine, 2003;349:446-455