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International variation in vitamin prescription and association with mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

International variation in vitamin prescription and association with mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Authors :
Friedrich K. Port
David A. Goodkin
Jennifer L. Bragg-Gresham
Brenda W. Gillespie
Eric W. Young
Takashi Akiba
Juergen Bommer
Akira Saito
Rachel B. Fissell
Source :
American journal of kidney diseases : the official journal of the National Kidney Foundation. 44(2)
Publication Year :
2004

Abstract

Background: The prevalence of water-soluble vitamin use among hemodialysis (HD) patients and whether mortality and hospitalization are associated with water-soluble vitamin use by HD patients have not previously been reported. The present study investigates patterns of water-soluble vitamin use among HD patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) I and evaluates outcomes associated with vitamin use. Methods: The study sample came from the DOPPS I, a prospective observational study of adult HD patients (N = 16,345) randomly selected from 308 representative dialysis facilities in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States. Time-dependent Cox regression models were used to assess relative risk (RR) for mortality and hospitalization for patients administered water-soluble vitamins versus those not administered water-soluble vitamins. Results: There was large variation by region in the percentage of patients administered water-soluble vitamins: Europe ranged from a low of 3.7% in the United Kingdom to a high of 37.9% in Spain; 5.6% in Japan; and 71.9% in the United States. Patient use of water-soluble vitamins was associated with a substantially and significantly lower risk for mortality (RR, 0.84; P = 0.001). Lower RR for facility-level mortality also was associated with greater water-soluble vitamin use (RR, 0.98; P = 0.05 per 10% more patients administered water-soluble vitamins at the facility). Conclusion: Although only a randomized trial could prove that water-soluble vitamins improve outcomes, use of water-soluble vitamins is a minimal-risk practice pattern associated with improved outcomes in this prospective observational study.

Details

ISSN :
15236838
Volume :
44
Issue :
2
Database :
OpenAIRE
Journal :
American journal of kidney diseases : the official journal of the National Kidney Foundation
Accession number :
edsair.doi.dedup.....687b0bbed6f91a8d3339f3763728ac8c