Paricalcitol-treated patients experience improved hospitalization outcomes compared with calcitriol-treated patients in real-world clinical settings
Paricalcitol-treated patients experience improved hospitalization outcomes compared with calcitriol-treated patients in real-world clinical settings
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DOI：
10.1093/ndt/gfh123
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发表时间：
2004-05-01
影响因子：
6.1
通讯作者：
Sprague, SM
中科院分区：
文献类型：
--
作者：
Dobrez, DG;Mathes, A;Sprague, SM
背景。血钙、磷和完整甲状旁腺激素（PTH）异常与血液透析患者的发病率和死亡率相关。药物外注射维生素D用于纠正这些异常；然而，维生素D治疗和住院之间的关系从未得到解决。研究人员分析了1999年1月至2001年11月11443名接受过至少10次维生素D治疗的成人血液透析患者的医疗数据。使用多变量模型来评估维生素D治疗对以下方面的影响：(i)住院总人数，（ii）住院总天数，（iii）开始维生素D治疗后首次住院的风险。与骨化三醇组相比，特化三醇组首次全因住院的风险较低（可能性降低14%，P < 0.0001），每年住院次数较少（减少0.642次，P < 0.001），每年住院天数较少（减少6.84天，P < 0.001）。在白藜芦醇组和骨化三醇组中，分别有5.6%和41.3%的患者改用另一种维生素D化合物。对于那些开始并一直服用相同维生素D产品的患者，接受特品醇治疗的患者每年住院次数减少0.846次，每年住院天数减少9.17天，两者的P < 0.001。paricalcitol组首次与甲状旁腺激素相关住院的风险较低，与甲状旁腺激素相关的年度住院次数较少，每年住院天数较少。与骨化三醇治疗的患者相比，paricalcitol治疗的患者每年住院次数和住院天数更少。开始用特立醇进行维生素D治疗可能会导致每位患者每年节省大约7600-11000美元。一项随机、对照、盲法研究将有助于确认和理解这些结果。
Background. Abnormalities of serum calcium, phosphorous and intact parathyroid hormone (PTH) are associated with morbidity and mortality in haemodialysis patients. Pharmacologic parenteral vitamin D administration is used to correct these abnormalities; however, the relationship between vitamin D therapies and hospitalizations has never been addressed.Methods. Healthcare data from January 1999 to November 2001 were analysed for 11443 adult haemodialysis patients who received at least 10 doses of vitamin D therapy. Multivariate models were used to evaluate the effects of vitamin D therapy on: (i) total number of hospitalizations, (ii) total number of hospital days and (iii) risk of first hospitalization after initiation of vitamin D therapy.Results. When compared with the calcitriol group, the paricalcitol group had a lower risk of first all-cause hospitalization (14% less likely, P < 0.0001), fewer hospitalizations per year (0.642 fewer, P < 0.001) and fewer hospital days per year (6.84 fewer, P < 0.001). In the paricalcitol and calcitriol groups, respectively, 5.6 and 41.3% patients switched to another vitamin D compound. For those patients who started and remained on the same vitamin D product, paricalcitol-treated patients experienced 0.846 fewer hospitalizations per year and 9.17 fewer hospital days per year, P < 0.001 for both. The paricalcitol group also had a lower risk of first PTH-related hospitalizations, fewer PTH-related annual hospitalizations and fewer days per year.Conclusion. Paricalcitol-treated patients experienced fewer hospitalizations and hospital days per year when compared with calcitriol-treated patients. Initiating vitamin D therapy with paricalcitol may result in overall savings of similar to$7600-11000 per patient per year. A randomized, controlled, blinded study would be valuable in confirming and understanding these results.