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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.

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  • Authors+Show Affiliations

    ,

    Renal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

    , , , , , , , , ,

    Source

    Kidney international 72:8 2007 Oct pg 1004-13

    MeSH

    Aged
    Calcium
    Case-Control Studies
    Cohort Studies
    Cross-Sectional Studies
    Female
    Humans
    Hyperparathyroidism
    Kidney Failure, Chronic
    Male
    Middle Aged
    Multivariate Analysis
    Parathyroid Hormone
    Phosphorus
    Prospective Studies
    Renal Dialysis
    Risk Factors
    Survival Analysis
    Vitamin D
    Vitamin D Deficiency

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17687259

    Citation

    Wolf, M, et al. "Vitamin D Levels and Early Mortality Among Incident Hemodialysis Patients." Kidney International, vol. 72, no. 8, 2007, pp. 1004-13.
    Wolf M, Shah A, Gutierrez O, et al. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int. 2007;72(8):1004-13.
    Wolf, M., Shah, A., Gutierrez, O., Ankers, E., Monroy, M., Tamez, H., ... Thadhani, R. (2007). Vitamin D levels and early mortality among incident hemodialysis patients. Kidney International, 72(8), pp. 1004-13.
    Wolf M, et al. Vitamin D Levels and Early Mortality Among Incident Hemodialysis Patients. Kidney Int. 2007;72(8):1004-13. PubMed PMID: 17687259.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Vitamin D levels and early mortality among incident hemodialysis patients. AU - Wolf,M, AU - Shah,A, AU - Gutierrez,O, AU - Ankers,E, AU - Monroy,M, AU - Tamez,H, AU - Steele,D, AU - Chang,Y, AU - Camargo,C A,Jr AU - Tonelli,M, AU - Thadhani,R, Y1 - 2007/08/08/ PY - 2007/8/10/pubmed PY - 2007/12/13/medline PY - 2007/8/10/entrez SP - 1004 EP - 13 JF - Kidney international JO - Kidney Int. VL - 72 IS - 8 N2 - 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. SN - 0085-2538 UR - https://www.unboundmedicine.com/medline/citation/17687259/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)52770-1 DB - PRIME DP - Unbound Medicine ER -