COMPARISON OF

ORAL VERSUS
INTRAVENOUS
VITAMIN D
RECEPTOR
ACTIVATOR IN
REDUCING
INFECTION-RELATED
MORTALITY IN
HEMODIALYSIS
PATIENTS
-THE Q-COHORT
STUDY-

FRANS SARUMPAET, dr.

PEMBIMBING :
BAYU RUSFANDI, dr., SpPD

INTRODUCTION
Common Complication
of CKD
- Vitamin D deficiency
- Hyperparathyroidisim

Vitamin D Deficiency

Survival Rate of CKD

patients

VITAMIN D RECEPTOR
ACTIVATOR (VDRA)

VDRA FUNCTIONS
:
- Prevent CKD
Mineral Bone
Disorder
Immunomodulato
r
- Anti
Inflammation

MORTALITY RISK OF CKD

VDRA ROUTE
OF
PATIENTS
ADMINISTRATION

ADMINISTRATION
How VDRA
preventing
infection differ
according to d
administration
route
- IV Mortality
Risk
-- Oral

The Optimal
route of
Administriatio
n of VDRA
Remain
inconclusive
ORAL? IV?

Study of Tentori
(2009) &
Chowdhury
(2014)
Theres no
Association
Between
Vitamin D &
Improved
Outcomes in
CKD Patients

METHODS
SAMPLE
3372 Px
Male/Female
18 yrs
On HD
Outpatient in Kyushu,
Japan
From 2006-2007,
followed till 2010

BASELINE DATA
Age, sex, dialysis vintage,
predialysis blood
pressure, duration of
dialysis per session,
dialysate calcium (Ca),
Alb, Ca, phosphorus,
ALP and PTH
concentrations,
Kt/V, normalized protein
catabolic rate (NPCR) &
use of phosphate binders

PRIMARY
OUTCOME
The incidence
of
death From
infection

STATISTICAL ANALYSIS
The KruskalWallis one-way test used to compare differences
between oral, intravenous and no VDRA Groups
Fishers exact test to compare Categorical variables
Logistic regression model to calculate the Propensity scores
Harrells C index and May and Hosmers method To evaluate
Model performance
Cox proportional hazards model to estimate Hazard Ratio
Cox regression model to estimate The association between VDRA
treatment and infection-related mortality
KaplanMeier survival curves to estimate survival rate

RESULTS
2360
px
(70.0
%)

received
VDRA
4 year
follow
up

548 px
(16.3%
)
DIED
The
Associat
ion
Betwwe
n VDRA
use &
Survival
Rate

SUBJECTS WHO GET IV VDRA were

Younger in age
Less frequently male
Had longer dialysis vintages
Value of diastolic BP,
Ca phosphorus, ALP and PTH
concentrations
prescription rates for sevelamer

THE OVERAL 4 YEAR SURVIVAL RATE

118 px (3.5%) DIED of infection
SURVIVAL RATES for VDRA px = IV px :
98.2%; ORAL px : 96.0%; & Non VDRA :
93.6%
UNADJUSTED COX ANALYSIS
There is a significant association between
any type of VDRA therapy and infectionrelated mortality (HR=0.53)
ADJUSTED MULTIVARIABLE COX ANALYSIS
that use of VDRA was independently
associated with a lower incidence of
infection-related death (HR = 0.54)

than those
who received
oral VDRA

Table 1

VDRA px HAD
BETTER
SURVIVAL RATE
than non-VDRA
user
Figure

1&2
the results from a
competing risk
and standard
Cox regression
models did not
differ substantially

Table 3

DISCUSSION

CONCLUSION
This study suggests that
intravenous VDRA
Has a more favorable effect on
incidence of infection-related
mortality in hemodialysis
patients than oral VDRA in
clinical Practice

THANK
YOU

RETURN TO
RESULTS

RETURN TO
RESULTS