Vitamin D levels and early mortality among incident hemodialysis patients

Abstract

Vitamin D deficiency is associated with cardiovascular disease, the most common cause of mortality in hemodialysis patients. To investigate the relation between blood levels of 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) with hemodialysis outcomes, we measured baseline vitamin D levels in a cross-sectional analysis of 825 consecutive patients from within a prospective cohort of incident US hemodialysis patients. Of these patients, 78% were considered vitamin D deficient with 18% considered severely deficient. Calcium, phosphorus, and parathyroid hormone levels correlated poorly with 25D and 1,25D concentrations. To test the association between baseline vitamin D levels and 90-day mortality, we selected the next 175 consecutive participants who died within 90 days and compared them to the 750 patients who survived in a nested case-control analysis. While low vitamin D levels were associated with increased mortality, significant interaction was noted between vitamin D levels, subsequent active vitamin D therapy, and survival. Compared to patients with the highest 25D or 1,25D levels who received therapy, untreated deficient patients were at significantly increased risk for early mortality. Our study shows that among incident hemodialysis patients, vitamin D deficiency is common, correlates poorly with other components of mineral metabolism and is associated with increased early mortality.

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

“…Wolf et al showed that among incident haemodialysis patients, those with 25(OH)D levels < 10 ng/mL (25 nmol/L) were at increased risk of 90 day mortality, compared with subjects with 25(OH)D > 30 ng/mL (75 nmol/L). The risk for cardiovascular‐related mortality was also higher for patients with 25(OH)D between 10 to 30 ng/mL (25 to 75 nmol/L) 168. Similar data have been reported for non‐dialysis patients in two prospective studies of small sample size 169, 170.…”

Progression of Coronary Artery Calcification and Thoracic Aorta Calcification in Kidney Transplant Recipients

“…Studies in dialysis patients as well as in renal transplant recipients have demonstrated the strong association of CVE history with CAC, the latter most likely related to atherosclerosis (23,24,25,19) (30). Observational studies already showed that vitamin D deficiency is associated with increased risks for cardiovascular disease and death in the general population (31,32), with heart failure in patients referred for coronary angiography (33) and with mortality in hemodialysis and CKD patients (34,35). Moreover low 25-(OH) vitamin D3 levels are associated with traditional atherosclerosis risk factors (36)(37)(38)(39).…”

Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice

“…Studies in these patients have shown that they commonly suffer from vitamin D deficiency [9][10][11]. Low 25(OH)D levels have been associated with atherosclerosis and endothelial dysfunction in patients with end stage renal disease and on hemodialysis [12] and increased 90-day mortality in patients on hemodialysis [11]. Furthermore, in patients with CKD 2-5, the 25(OH)D level is an independent predictor of disease progression and mortality [10;13].…”