Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients

Abstract

AimsDialysis patients experience an excess mortality, predominantly of sudden cardiac death (SCD). Accumulating evidence suggests a role of vitamin D for myocardial and overall health. This study investigated the impact of vitamin D status on cardiovascular outcomes and fatal infections in haemodialysis patients.Methods and results25-hydroxyvitamin D [25(OH)D] was measured in 1108 diabetic haemodialysis patients who participated in the German Diabetes and Dialysis Study and were followed up for a median of 4 years. By Cox regression analyses, we determined hazard ratios (HR) for pre-specified, adjudicated endpoints according to baseline 25(OH)D levels: SCD (n = 146), myocardial infarction (MI, n = 174), stroke (n = 89), cardiovascular events (CVE, n = 414), death due to heart failure (n = 37), fatal infection (n = 111), and all-cause mortality (n = 545). Patients had a mean age of 66 ± 8 years (54% male) and median 25(OH)D of 39 nmol/L (interquartile range: 28–55). Patients with severe vitamin D deficiency [25(OH)D of≤ 25 nmol/L] had a 3-fold higher risk of SCD compared with those with sufficient 25(OH)D levels >75 nmol/L [HR: 2.99, 95% confidence interval (CI): 1.39–6.40]. Furthermore, CVE and all-cause mortality were strongly increased (HR: 1.78, 95% CI: 1.18–2.69, and HR: 1.74, 95% CI: 1.22–2.47, respectively), all persisting in multivariate models. There were borderline non-significant associations with stroke and fatal infection while MI and deaths due to heart failure were not meaningfully affected.ConclusionSevere vitamin D deficiency was strongly associated with SCD, CVE, and mortality, and there were borderline associations with stroke and fatal infection. Whether vitamin D supplementation decreases adverse outcomes requires further evaluation.

Effect of Paricalcitol on Left Ventricular Mass and Function in CKD—The OPERA Trial

“…In line with these experimental evidences, considerable epidemiologic data showed an important link between vitamin D deficiency and adverse cardiovascular outcomes in both the general population 14,24,25 and patients with CKD. 15,26,27 Some retrospective and observational analyses as well as shortterm uncontrolled data suggested potential survival or cardiovascular benefit of 1,25(OH) 2 D 3 treatment in patients with CKD. [17][18][19]28,29 However, controlled data remain scarce.…”

Active Vitamin D Treatment for Reduction of Residual Proteinuria

“…[19][20][21] In CKD patients, lower vitamin D concentrations have been associated with an increased risk of mortality, 22,23 cardiovascular complications, 24 and renal disease progression. 25 These findings have resulted in a number of small-to mediumsized prospective randomized controlled trials (RCTs) with the use of active vitamin D analogs targeting reduction of (residual) proteinuria in CKD patients.…”

Role of Vitamin D in Various Illnesses: A Review

“…Drechsler et al investigated the impact of vitamin D status on cardiovascular outcomes and fatal infections in haemodialysis patients and reported that severe vitamin D deficiency was strongly associated with sudden cardiac death, cardiac vascular event, and mortality, and there were borderline associations with stroke and fatal infection [10]. Findings from RCTs among patients free of advanced CKD have to be very cautiously extrapolated to haemodialysis patients.…”

“…Two more studies among African Americans also showed a high prevalence of vitamin D deficiency in patients with heart failure. Interestingly, not all heart failure patients with vitamin D deficiency show elevations in PTH levels, but those with secondary hyperparathyroidism have more severe forms of heart failure [10].…”