| Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. | |
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MedLine Citation:
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PMID: 12890843 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Elevated calcium and phosphorus levels after therapy with injectable vitamin D for secondary hyperparathyroidism may accelerate vascular disease and hasten death in patients undergoing long-term hemodialysis. Paricalcitol, a new vitamin D analogue, appears to lessen the elevations in serum calcium and phosphorus levels, as compared with calcitriol, the standard form of injectable vitamin D. METHODS: We conducted a historical cohort study to compare the 36-month survival rate among patients undergoing long-term hemodialysis who started to receive treatment with paricalcitol (29,021 patients) or calcitriol (38,378 patients) between 1999 and 2001. Crude and adjusted survival rates were calculated and stratified analyses were performed. A subgroup of 16,483 patients who switched regimens was also evaluated. RESULTS: The mortality rate among patients receiving paricalcitol was 3417 per 19,031 person-years (0.180 per person-year), as compared with 6805 per 30,471 person-years (0.223 per person-year) among those receiving calcitriol (P<0.001). The difference in survival was significant at 12 months and increased with time (P<0.001). In the adjusted analysis, the mortality rate was 16 percent lower (95 percent confidence interval, 10 to 21 percent) among paricalcitol-treated patients than among calcitriol-treated patients. A significant survival benefit was evident in 28 of 42 strata examined, and in no stratum was calcitriol favored. At 12 months, calcium and phosphorus levels had increased by 6.7 and 11.9 percent, respectively, in the paricalcitol group, as compared with 8.2 and 13.9 percent, respectively, in the calcitriol group (P<0.001). The two-year survival rate among patients who switched from calcitriol to paricalcitol was 73 percent, as compared with 64 percent among those who switched from paricalcitol to calcitriol (P=0.04). CONCLUSIONS: Patients who receive paricalcitol while undergoing long-term hemodialysis appear to have a significant survival advantage over those who receive calcitriol. A prospective, randomized study is critical to confirm these findings. |
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Authors:
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Ming Teng; Myles Wolf; Edmund Lowrie; Norma Ofsthun; J Michael Lazarus; Ravi Thadhani |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The New England journal of medicine Volume: 349 ISSN: 1533-4406 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2003 Jul |
Date Detail:
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Created Date: 2003-07-31 Completed Date: 2003-08-04 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: United States |
Other Details:
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Languages: eng Pagination: 446-56 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2003 Massachusetts Medical Society |
Affiliation:
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Fresenius Medical Care North America, Lexington, Mass, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Calcitriol / therapeutic use* Calcium / blood Cohort Studies Ergocalciferols / therapeutic use* Female Follow-Up Studies Humans Hyperparathyroidism / drug therapy*, etiology Kidney Failure, Chronic / blood, mortality, therapy* Male Middle Aged Parathyroid Hormone / blood Phosphorus / blood Renal Dialysis / mortality* Renal Osteodystrophy / prevention & control Retrospective Studies Survival Rate |
| Chemical | |
Reg. No./Substance:
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0/Ergocalciferols; 0/Parathyroid Hormone; 131918-61-1/paricalcitol; 32222-06-3/Calcitriol; 7440-70-2/Calcium; 7723-14-0/Phosphorus |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 2003 Jul 31;349(5):496-9
[PMID:
12890849
]
N Engl J Med. 2003 Nov 13;349(20):1971-2; author reply 1971-2 [PMID: 14626257 ] N Engl J Med. 2003 Nov 13;349(20):1971-2; author reply 1971-2 [PMID: 14626256 ] N Engl J Med. 2003 Nov 13;349(20):1971-2; author reply 1971-2 [PMID: 14614175 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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