Trends and Variations in Intravenous Vitamin D Use among Hemodialysis Patients in the United States

Figures & data

Table 1.  Baseline characteristics of patients between 1999 and 2008.

						Cause of ESRD
Year	N	Mean age^a (SD)	Male (%)	White (%)	Black (%)	Hypertension (%)	Diabetes (%)	GN^b (%)
1999	225,022	59.0 (17.0)	52.0	56.5	37.8	29.9	41.1	14.1
2000	235,917	59.1 (17.0)	52.2	56.7	37.6	29.6	41.7	13.8
2001	250,940	59.3 (17.0)	52.3	57.0	37.2	29.4	42.5	13.3
2002	268,680	59.6 (17.0)	52.8	57.4	36.9	29.4	42.9	13.0
2003	278,938	59.6 (16.9)	53.0	57.3	36.9	29.4	43.4	12.6
2004	291,255	59.6 (16.9)	53.4	57.2	36.9	29.5	43.7	12.3
2005	301,534	59.5 (16.9)	53.7	57.2	36.7	29.4	44.1	12.1
2006	304,273	59.4 (16.9)	53.9	57.1	36.9	29.3	44.4	11.8
2007	307,919	59.2 (16.9)	54.2	57.0	37.0	29.2	44.5	11.6
2008	315,608	59.1 (16.8)	54.3	57.0	37.0	29.2	44.7	11.4

Notes: ESRD, end-stage renal disease; SD, standard deviation; GN, glomerulonephritis.

^aAge at dialysis initiation.

^bPrimary or secondary GN.

Figure 1. Annual percentage of patients treated with IV vitamin D by formulation.

Figure 2. Annual percentage of vitamin D users by race.

Table 2. Mean annual IV vitamin D dose (mcg) administered per patient by race.

	Race
Year	White	Black
1999	47.7	69.6
2000	45.1	92.8
2001	53.0	104.3
2002	59.0	117.7
2003	51.9	113.0
2004	55.6	117.9
2005	61.1	121.4
2006	65.9	127.9
2007	69.1	129.7
2008	73.6	136.0

Figure 3. Annual percentage of vitamin D users by sex.

Table 3. Mean annual IV vitamin D dose (mcg) administered per patient by formulation.

	Calcitriol	Paricalcitol	Doxercalciferol
Year	Mean dose (SD)	Mean dose (SD)	Mean dose (SD)
1999	94.9 (3458)	7.97 (4.49)	0.0 (0.0)
2000	74.8 (320.3)	79.5 (431)	0.0 (0.0)
2001	70.6 (216.0)	99.4 (389)	0.0 (0.1)
2002	74.3 (150.3)	108 (552)	6.3 (42.9)
2003	81.2 (1802)	90.6 (144)	8.4 (32.1)
2004	72.6 (146.1)	91.6 (124.8)	89.3 (158)
2005	73.4 (93.2)	95.8 (195)	95.5 (85.7)
2006	78.4 (92.7)	97.0 (110)	103.0 (137)
2007	78.2 (97.2)	96.6 (103)	107.0 (120)
2008	69.8 (87.6)	105.0 (118)	112.0 (111)

Note: SD, standard deviation.

Table 4. Logistic regression model predicting vitamin D use (yes/no) and multiple regression model predicting annual vitamin D dose (mcg) per patient in 2008.

	Vitamin D use		Annual vitamin D dose
	(OR)	95% CI	Parameter estimate	p-Value
Age (reference group is age greater than 65 years)
0–18 years	0.59	0.54–0.65	−25.0	<0.0001
18–64 years	1.24	1.21–1.27	12.9	<0.0001
Male sex	0.97	0.95–0.99	2.90	<0.0001
Black race	2.38	2.32–2.43	52.7	<0.0001
Cause of ESRD (reference group is diabetes mellitus)
Hypertension	0.94	0.91–0.96	−2.36	0.0002
GN	0.79	0.77–0.82	−8.81	<0.0001
Other	0.71	0.69–0.73	−7.71	<0.0001
Vintage (years)	1.07	1.06–1.07	4.02	<0.0001
CAD	1.08	1.06–1.11	0.44	0.34
CHF	0.92	0.90–0.94	−3.21	<0.0001
TIA	0.88	0.86–0.90	−6.75	<0.0001
PVD	1.02	1.00–1.04	0.34	0.0021
Other cardiac disease	1.04	1.02–1.06	1.34	0.016
Liver disease	0.88	0.85–0.91	−10.7	<0.0001
COPD	0.90	0.88–0.92	−1.35	0.0037
Gastrointestinal bleed	0.81	0.79–0.84	−11.1	<0.0001
Dysrhythmia	0.87	0.85–0.89	−11.0	<0.0001
Cancer	0.82	0.80–0.84	−8.24	<0.0001
Diabetes mellitus	0.97	0.94–0.99	−0.73	0.16

Notes: OR, odds ratio; CI, confidence interval; ESRD, end-stage renal disease; GN, glomerulonephritis; CAD, coronary artery disease; CHF, congestive heart failure; TIA, transient ischemic attack; PVD, peripheral vascular disease; COPD, chronic obstructive pulmonary disorder.

Figure 4. Annual vitamin D dose per patient by state among both white and black patients (1999–2008).

Figure 5. Annual vitamin D dose per patient by state among only black patients (1999–2008).