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The association of vitamin D use with hypercalcemia and hyperphosphatemia in hemodialysis patients: a case–crossover study
Author(s) -
Kilpatrick Ryan D.,
Danese Mark D.,
Belozeroff Vasily,
Smirnakis Karen,
Goodman William G.,
Rothman Kenneth J.
Publication year - 2011
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.2183
Subject(s) - medicine , hyperphosphatemia , hemodialysis , crossover study , vitamin d and neurology , intensive care medicine , kidney disease , alternative medicine , pathology , placebo
Purpose Elevated levels of phosphorus (P) and calcium (Ca) have been shown in observational studies to be associated with an increased risk of adverse clinical outcomes including mortality. Vitamin D sterols have been shown to increase the risk of hypercalcemia and hyperphosphatemia in clinical trials. We sought to explore these risks in real‐world clinical practice. Methods We employed a case–crossover design, which eliminates confounding by non‐time‐varying patient characteristics by comparing, within each patient, vitamin D doses before the event with those at an earlier period. Using this method, we estimated the risk of hypercalcemic (Ca ≥ 11 g/dL) and hyperphosphatemic (P ≥ 8 g/dL) events for patients at different dose quartiles of vitamin D relative to patients not on a vitamin D sterol. Results There was a dose‐dependent association between vitamin D dose quartile and risk of hypercalcemia or hyperphosphatemia. In adjusted analyses, each increase in vitamin D quartile was associated with a multiple of hypercalcemia risk between 1.7 and 19 times compared with those not on vitamin D and a multiple of hyperphosphatemia risk between 1.8 and 4. Conclusion Use of vitamin D sterols is associated with an increased risk of hypercalcemic and hyperphosphatemic events in real‐world clinical practice. Other potential predictors of these events, such as phosphate binder use and dialysate Ca levels, were not examined in this analysis. Copyright © 2011 John Wiley & Sons, Ltd.