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Frans Sarumpaet, Dr. Pembimbing: Bayu Rusfandi, DR., SPPD
Frans Sarumpaet, Dr. Pembimbing: Bayu Rusfandi, DR., SPPD
ORAL VERSUS
INTRAVENOUS
VITAMIN D
RECEPTOR
ACTIVATOR IN
REDUCING
INFECTION-RELATED
MORTALITY IN
HEMODIALYSIS
PATIENTS
-THE Q-COHORT
STUDY-
INTRODUCTION
Common Complication
of CKD
- Vitamin D deficiency
- Hyperparathyroidisim
Vitamin D Deficiency
VITAMIN D RECEPTOR
ACTIVATOR (VDRA)
VDRA FUNCTIONS
:
- Prevent CKD
Mineral Bone
Disorder
Immunomodulato
r
- Anti
Inflammation
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
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