Intravenous Vitamin D Treatment in Hemodialysis Patients: Patterns of Use and Association with Fracture Risk Public Deposited

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  • March 22, 2019
  • Beaubrun, Anne Christine
    • Affiliation: Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy
  • The administration of intravenous vitamin D therapy is central to the treatment of secondary hyperparathyroidism. Yet, there is little data documenting the variations in the use of these agents in large, representative samples and vitamin D's clinical benefits are not clear. The objectives of this dissertation were to describe patterns in the use of vitamin D and to examine the association between vitamin D exposure and fracture risk among hemodialysis patients. We described vitamin D-related trends among patients within the United States Renal Data System between 01/01/2000-12/31/2008. Annual percentages of patients treated with each formulation were tabulated by relevant subgroups. A retrospective cohort study was conducted to examine the association between vitamin D exposure and fracture risk. Incident hemodialysis patients between 01/01/2000-05/31/2004 entered a 180-day baseline period where vitamin D exposure was assessed. Time to the first fracture hospitalization was assessed over one year using multivariable Cox proportional hazard regression. The key measures of vitamin exposure were measured at the facility-level: 1) the proportion of vitamin D users/facility (derived using mixed-effects logistic regression); and 2) the average vitamin D dose per patient (derived using mixed-effects linear regression). Fractures were grouped into four categories Vitamin D use has increased sharply from 58.6% of patients treated in 1999 to 83.9% of patients treated in 2008. Paricalcitol was the preferred formulation during the study years. In 2008, the average dose among black patients was 84% greater than among white patients. No significant relation was observed between the proportion of vitamin D users or the average vitamin D dose per patient at the facility-level and fracture rates for all fracture types. Specifically, for any fracture, the hazard ratio (HR) in adjusted models for a facility's proportion of vitamin D users was 1.10 (95% CI 0.86-1.42) while the HR for a facility's average vitamin D dose per patient was 0.99 (95% CI 0.90-1.09). In summary, vitamin D use has increased and parallels the rise in use of paricalcitol and doxercalciferol. Increasing vitamin D use and average vitamin D dose administered per patient within dialysis facilities did not have an observed beneficial association with fractures.
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  • In Copyright
  • Brookhart, M. Alan
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2013

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