Usage of vitamin D receptor activator (VDRA) for chronic kidney disease (CKD) including patients on dialysis patients has been controversial yet. It is unknown when to begin or discontinue VDRA therapy, the type of VDRA to administer, and the method of delivery, intravenous or oral for survival in CKD patients. Therefore, we examined whether intravenous or oral VDRA early after dialysis initiation affected mortality in incident dialysis patients. Methods The study database was derived from the

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... ichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP), a multicenter, prospective, cohort analysis of 1,520 consecutive patients who began dialysis at the 17 AICOPP group centers between October 2011 and September 2013. We excluded the 262 patients who died by March 2015, 15 patients were lost to follow-up, 241 patients with unconfirmed information about use of VDRA in March 2015, and 35 patients who discontinued VDRA between dialysis initiation and March 2015. Finally, 967 patients participated in the present study. We classified the participating patients into three groups according to the usage of VDRA in March 2015: no use of VDRA (NV group), oral VDRA (OV group), and intravenous VDRA (IV group) and compared their all-cause mortality. Results There were 104 deaths during the follow-up period (NV group, 27 cases; OV group, 53 cases; IV group, 24 cases). Significant differences between the cumulative survival rates were observed for the three groups (p = 0.010). The IV group was associated with low all-cause mortality compared to the NV group (Hazard ratio = 0.46, 95% CI = 0.24−0.89, p = 0.020) by multivariate Cox proportional hazard analysis using the stepwise method. Conclusions Our study shows that early introduction of intravenous VDRA to patients on hemodialysis seems to be associated with better prognosis.