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Observational Study
. 2025 Apr;45(4):191-199.
doi: 10.1007/s40261-025-01429-8. Epub 2025 Mar 13.

Frequency of Acute Kidney Injury After the Initiation of Vitamin D Receptor Activators: A Multicenter Retrospective Observational Study

Masanori Nakanishi #  1 , Tomohiro Mizuno #  2 , Shinya Sakai  3 , Daiki Hira  3 , Takenao Koseki  1 , Takeshi Matsubara  4 , Hideki Yokoi  4 , Motoko Yanagita  4 , Tomohiro Terada  3 , Shigeki Yamada  1 , Naotake Tsuboi  5
Affiliations
Observational Study

Frequency of Acute Kidney Injury After the Initiation of Vitamin D Receptor Activators: A Multicenter Retrospective Observational Study

Masanori Nakanishi et al. Clin Drug Investig. 2025 Apr.

Abstract

Background and objectives: Vitamin D receptor activators (VDRAs) are widely used in patients with osteoporosis; however, the frequency of acute kidney injury (AKI) due to VDRAs is unclear. This study aimed to investigate whether the incidence of AKI after VDRA initiation differed among patients with different renal functions.

Methods: The medical records of Japanese patients who were newly prescribed with VDRAs for osteoporosis at the Fujita Health University Hospital or Kyoto University Hospital between April 2012 and March 2022 were retrospectively reviewed in this study. The RIFLE (Risk, Injury, Failure, Loss of function, End-stage kidney disease) criteria were used to assess the incidence of AKI within 7 days after initiation of VDRA therapy. Additionally, the AKI algorithm was used to assess the incidence of AKI from 8 to 365 days after initiation of VDRA therapy.

Results: The incidence of AKI, as defined by the RIFLE criteria, was significantly higher in patients with normal renal function or end-stage renal failure than in those with mild renal decline (p < 0.05); the incidence of AKI, defined using the AKI algorithm, showed a similar trend. We found that the lack of serum calcium level monitoring before the initiation of VDRAs might be a risk factor for AKI defined by the RIFLE criteria (odds ratio = 2.004, p = 0.096).

Conclusions: The incidence of AKI after the initiation of VDRA therapy was high, even if renal function was normal. Thus, our results suggest that monitoring serum calcium levels before the initiation of VDRA therapy is necessary, regardless of renal function.

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Conflict of interest statement

Declarations. Funding: No funding was received for the conduct of this study or the preparation of this article. Conflict of interest: Within 36 months, Shigeki Yamada has received honoraria from EA Pharma Co., Ltd. and Takeda Pharmaceutical Co., Ltd. Tomohiro Mizuno has received honoraria from Kyowa Kirin Co., Ltd. and Sumitomo Pharma Co., Ltd. Tomohiro Mizuno is an editorial board member of Clinical Drug Investigation. Tomohiro Mizuno was not involved in the selection of peer reviewers for the manuscript or in any of the subsequent editorial decisions. Masanori Nakanishi, Shinya Sakai, Daiki Hira, Takenao Koseki, Takeshi Matsubara, Hideki Yokoi, Motoko Yanagita, Tomohiro Terada, and Naotake Tsuboi have no conflicts of interest that are directly relevant to the content of this article. Ethics approval: This research was approved by the ethics boards of Fujita Health University Hospital (ethics committee approval number: HM22-224) and Kyoto University Hospital (ethics committee approval number: R3634) and was conducted in accordance with the appropriate guidelines. Consent to participate: Because this was a retrospective cohort study, an opt-out approach for obtaining informed consent was used with the approval of the ethics board. Consent for publication: Not applicable. Availability of data and material: Data archiving is not mandated but data will be made available on reasonable request. Code availability: Not applicable. Authors’ contributions: MN and TM contributed to the study conception and design, analyzed the data, and drafted the manuscript. MN, SS, and HD interpreted the data. SS and HD contributed to drafting the manuscript and the study design. TK, YM, HY, MY, TT, SY, and NT designed the study and reviewed the manuscript. All authors read and approved the final version.

References

    1. Isakova T, Nickolas TL, Denburg M, Yarlagadda S, Weiner DE, Gutiérrez OM, et al. KDOQI US commentary on the 2017 KDIGO clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Am J Kidney Dis. 2017;70(6):737–51. - PubMed
    1. Habas E Sr, Eledrisi M, Khan F, Elzouki AY. Secondary hyperparathyroidism in chronic kidney disease: pathophysiology and management. Cureus. 2021;13(7): e16388. - PubMed - PMC
    1. Hamdy NA, Kanis JA, Beneton MN, Brown CB, Juttmann JR, Jordans JG, et al. Effect of alfacalcidol on natural course of renal bone disease in mild to moderate renal failure. BMJ. 1995;310(6976):358–63. - PubMed - PMC
    1. Coburn JW, Maung HM, Elangovan L, Germain MJ, Lindberg JS, Sprague SM, et al. Doxercalciferol safely suppresses PTH levels in patients with secondary hyperparathyroidism associated with chronic kidney disease stages 3 and 4. Am J Kidney Dis. 2004;43(5):877–90. - PubMed
    1. Wang AY, Fang F, Chan J, Wen YY, Qing S, Chan IH, et al. Effect of paricalcitol on left ventricular mass and function in CKD: the OPERA trial. J Am Soc Nephrol. 2014;25(1):175–86. - PubMed

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