Posted on 02/28/2005 4:35:59 PM PST by Coleus
Half of dialysis patients fail to receive life-saving vitamin
An article published online in advance of the April issue of the Journal of the American Society of Nephrology (www.jasn.org) found that administering injectable vitamin D to chronic kidney failure patients who are undergoing dialysis significantly improves survival. The annual mortality rate of dialysis patients is currently 20 percent in the United States, due mainly to cardiovascular disease.
Because individuals with failing kidneys cannot effectively utilize vitamin D provided by the diet, injections have been recommended, but only for those with hyperparathyroidism meaning that about half of those receiving dialysis are lacking in the vitamin. The current research sought to determine the impact on survival of vitamin D injections in dialysis patients.
Director of clinical research at Massachusetts General Hospital, Ravi Thadhani, MD, and researchers from Fresenius Medical Care North America analyzed information from 51,037 patients who received dialysis at Fresenius centers beginning in 1996 to 1999. Activated injectable vitamin D was received by 37,173 of the patients in this study, while the remaining 13,864 subjects did not receive the vitamin.
After two years of dialysis, 76 percent of those who received vitamin D injections were still living, compared to 59 percent of patients who did not receive the vitamin. Elevation of calcium or phosphorus secondary to treatment with vitamin D did not adversely impact survival in those who received it. Cardiovascular mortality of those who received no vitamin D was nearly double that of those who received it.
Dr Thadhani stated, "We've been administering vitamin D injections for decades, but the potential benefit on survival has never been studied. This finding was a surprise and should force us to think more broadly about who should be treated. While these results need to be verified, we at least need to be more aggressive in treating people that meet the current criteria. Thereafter we need to investigate what is the mechanism conferring this survival benefit. We are actively pursuing that with a focus on the effects on cardiovascular disease."
For many years, the Centers for Disease Control (CDC) has listed kidney disease as one of the top 10 causes of death by disease in the United States . Kidney disease also plays a significant role in hypertension and diabetes, two other diseases that are also included on the CDC's list of top ten causes of death each year. End-stage renal (kidney) disease (ESRD) is growing at a rate of 4-8% each year in the United States. Someone with advanced ESRD may require either therapeutic or regular dialysis, or both, and may eventually require a kidney transplant to save his or her life.
For patients who are in a predialysis stage, are undergoing dialysis, or are post-transplant, nutritional supplementation with L-carnitine that has been lost during dialysis may reduce the side effects of common renal problems, such as cardiomyopathy and blood platelet aggregation, and may also help improve the patient's perception of their overall quality of life. L-carnitine is an amino acid that has shown effectiveness in providing cellular energy in both healthy individuals and those with chronic diseases.
General muscle weakness is a common complaint among patients undergoing hemodialysis. One study that measured the serum amount of L-carnitine found that hemodialysis lowered L-carnitine levels and posed new problems for patients (Wanic-Kossowska et al. 1998). This study measured muscle atrophy via nerve conduction and velocity testing and found indications of "neurogenic atrophy of the muscles." This well-known type of muscle weakness was further studied by doctors in Japan who reported that low dosages of L-carnitine (500 mg daily) showed improvement in two-thirds of 30 patients who were studied for 12 weeks. The patients reported less muscle weakness, general fatigue, and cramps and aches. This study concluded that low doses of L-carnitine could improve muscle weakness and should be considered as a prolonged adjuvant therapy for dialysis patients (Sakurauchi et al. 1998).
Taurine is abundant in the brain, heart, gallbladder, and kidneys and plays an important role in health and disease in these organs. Taurine is an amino acid that has been shown to protect against experimentally induced lipid peroxidation of the renal glomerular and tubular cells and may alleviate tubular disorders such as glomerular impairment (Trachtman et al. 1996). It is also thought to lower blood pressure by balancing the ratio of sodium to potassium in the blood.
CLINICAL SCIENCE: Epidemiology and Outcomes |
1*Fresenius Medical Care North America, Lexington, the2
Renal Unit 3
Harvard School of Public Health, Boston, Massachusetts
To whom correspondence should be addressed. E-mail: thadhani.r@mgh.harvard.edu .
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Abstract |
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Patients with ESRD commonly experience secondary hyperparathyroidism, a condition primarily managed with activated injectable vitamin D. The biologic effects of vitamin D, however, are widespread, and it is possible that activated injectable vitamin D alters survival in ESRD. This hypothesis was tested in a historical cohort study of incident hemodialysis patients who lived throughout the United States between January 1996 and December 1999. The primary outcome was 2-yr survival among those who survived for at least 90 d after initiation of chronic hemodialysis.
During this period, 51,037 chronic hemodialysis patients survived for at least 90 d from the initiation of hemodialysis, and in the ensuing 2 yr, 37,173 received activated injectable vitamin D and 13,864 did not. At 2 yr, mortality rates were 13.8/100 person-years in the group that received injectable vitamin D compared with 28.6/100 person-years in the group that did not (P < 0.001).
Cox proportional hazards analyses adjusting for several potential confounders and examining injectable vitamin D therapy as a time-dependent exposure suggested that compared with patients who did not receive injectable vitamin D, the 2-yr survival advantage associated with the group that did receive injectable vitamin D was 20% (hazard ratio, 0.80; 95% confidence interval, 0.76 to 0.83).
The incidence of cardiovascular-related mortality was 7.6/100 person-years in the injectable vitamin D group,
compared with 14.6/100 person-years in the non-vitamin D group (P < 0.001). The benefit of injectable vitamin
D was evident in 48 of 49 strata examined, including those with low serum levels of intact parathyroid hormone
and elevated levels of serum calcium and phosphorus, situations in which injectable vitamin D is often withheld.
Repeating the entire analysis using marginal structural models to adjust for time-dependent confounding by indication yielded a survival advantage of 26% (hazard ratio, 0.74; 95% confidence interval, 0.71 to 0.79) associated with the injectable vitamin D group. In this historical cohort study, chronic hemodialysis patients in the group that received injectable vitamin D had a significant survival advantage over patients who did not. Randomized clinical trials would permit definitive conclusions.
Do you have link direct to the article?
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For Those Interested in the Research of Dr. Weston A. Price |
Well, well, well.
Thank you.
What is the source of the commentary? I'd like to provide a link to a special interest Yahoo group, or at least name the source if I have to use the FR link.
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