Newer vitamin D formulation appears to help dialysis patients live longer

Dialysis patients taking a particular intravenous vitamin D formulation have a significant survival advantage over patients taking an older and more commonly used form of vitamin D, according to a study published in the July 31, 2003, edition of the New England Journal of Medicine. Led by a Massachusetts General Hospital (MGH) physician, the three-year study found that patients receiving paricalcitol had a 16 percent greater chance of survival than did patients receiving calcitriol. The researchers stress that while this was a large-scale study of dialysis patients living throughout the United States, further studies are required before firm conclusions can be made.

"This is the first evidence that a specific form of vitamin D can change the high rate of mortality among dialysis patients," says Ravi Thadhani, MD, MPH, of the MGH Renal Unit, the paper's senior author. "If further research confirms our findings, this will be very important information for dialysis patients and their physicians."

Among the approximately 400,000 U.S. patients who receive dialysis for chronic kidney failure, the annual mortality rate is 20 percent. Several approaches have been tried to improve that statistic over the past decade, but few if any have been very successful. Cardiovascular disease is the primary cause of death among dialysis patients, and recently attention has been paid to the impact of hyperparathyroidism overactivity of the parathyroid gland on vascular disease.

Part of an imbalance in bone and mineral metabolism that results from kidney failure, hyperparathyroidism is usually treated with intravenous vitamin D therapy. However, treatment with vitamin D may exacerbate cardiovascular disease. Paricalcitol is a vitamin D analog that was approved by the U.S. Food and Drug Administration in 1998 to treat hyperparathyroidism associated with kidney failure. Because paricalcitol was known to be associated with more stable blood calcium and

Contact: Georgia Peirce
Massachusetts General Hospital

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