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Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD.
Am J Kidney Dis. 2011 Oct; 58(4):536-43.AJ

Abstract

BACKGROUND

Low 25-hydroxyvitamin D (25[OH]D) levels are common in patients with non-dialysis-dependent chronic kidney disease (CKD). The associations between low 25(OH)D levels and mortality in non-dialysis-dependent patients with CKD are unclear.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

Patients with stages 3-4 CKD (estimated glomerular filtration rate, 15-59 mL/min/1.73 m(2); n = 12,673) who had 25(OH)D levels measured after the diagnosis of CKD in the Cleveland Clinic Health System.

PREDICTOR

25(OH)D levels categorized into 3 groups: <15, 15-29, and ≥30 ng/mL.

OUTCOMES

We examined factors associated with low 25(OH)D levels and associations between low 25(OH)D levels and all-cause mortality (ascertained using the Social Security Death Index and our electronic medical record) using logistic regression, Cox proportional hazard models, and Kaplan-Meier survival curves.

MEASUREMENTS

25(OH)D was measured using chemiluminescence immunoassay.

RESULTS

Of 12,763 patients with CKD, 15% (n = 1,970) had 25(OH)D levels <15 ng/mL, whereas 45% (n = 5,749) had 25(OH)D levels of 15-29 ng/mL. Male sex, African American race, diabetes, coronary artery disease, and lower estimated glomerular filtration rate were associated significantly with 25(OH)D level <30 ng/mL. A graded increase in risk of 25(OH)D level <30 ng/mL was evident across increasing body mass index levels. Patients who had 25(OH)D levels measured in fall through spring had higher odds for 25(OH)D levels <30 ng/mL. After covariate adjustment, patients with CKD with 25(OH)D levels <15 ng/mL had a 33% increased risk of mortality (95% CI, 1.07-1.65). The group with 25(OH)D levels of 15-29 ng/mL did not show a significantly increased risk of mortality (HR, 1.03; 95% CI, 0.86-1.22) compared with patients with 25(OH)D levels ≥30 ng/mL.

LIMITATIONS

Single-center observational study, lack of data for albuminuria and other markers of bone and mineral disorders, and attrition bias.

CONCLUSIONS

25(OH)D level <15 ng/mL was associated independently with all-cause mortality in non-dialysis-dependent patients with CKD.

Authors+Show Affiliations

Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland, OH 44195, USA. navanes@ccf.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21816525

Citation

Navaneethan, Sankar D., et al. "Low 25-hydroxyvitamin D Levels and Mortality in Non-dialysis-dependent CKD." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 58, no. 4, 2011, pp. 536-43.
Navaneethan SD, Schold JD, Arrigain S, et al. Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD. Am J Kidney Dis. 2011;58(4):536-43.
Navaneethan, S. D., Schold, J. D., Arrigain, S., Jolly, S. E., Jain, A., Schreiber, M. J., Simon, J. F., Srinivas, T. R., & Nally, J. V. (2011). Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 58(4), 536-43. https://doi.org/10.1053/j.ajkd.2011.04.028
Navaneethan SD, et al. Low 25-hydroxyvitamin D Levels and Mortality in Non-dialysis-dependent CKD. Am J Kidney Dis. 2011;58(4):536-43. PubMed PMID: 21816525.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD. AU - Navaneethan,Sankar D, AU - Schold,Jesse D, AU - Arrigain,Susana, AU - Jolly,Stacey E, AU - Jain,Anil, AU - Schreiber,Martin J,Jr AU - Simon,James F, AU - Srinivas,Titte R, AU - Nally,Joseph V,Jr Y1 - 2011/08/04/ PY - 2010/10/28/received PY - 2011/04/26/accepted PY - 2011/8/6/entrez PY - 2011/8/6/pubmed PY - 2011/12/13/medline SP - 536 EP - 43 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 58 IS - 4 N2 - BACKGROUND: Low 25-hydroxyvitamin D (25[OH]D) levels are common in patients with non-dialysis-dependent chronic kidney disease (CKD). The associations between low 25(OH)D levels and mortality in non-dialysis-dependent patients with CKD are unclear. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Patients with stages 3-4 CKD (estimated glomerular filtration rate, 15-59 mL/min/1.73 m(2); n = 12,673) who had 25(OH)D levels measured after the diagnosis of CKD in the Cleveland Clinic Health System. PREDICTOR: 25(OH)D levels categorized into 3 groups: <15, 15-29, and ≥30 ng/mL. OUTCOMES: We examined factors associated with low 25(OH)D levels and associations between low 25(OH)D levels and all-cause mortality (ascertained using the Social Security Death Index and our electronic medical record) using logistic regression, Cox proportional hazard models, and Kaplan-Meier survival curves. MEASUREMENTS: 25(OH)D was measured using chemiluminescence immunoassay. RESULTS: Of 12,763 patients with CKD, 15% (n = 1,970) had 25(OH)D levels <15 ng/mL, whereas 45% (n = 5,749) had 25(OH)D levels of 15-29 ng/mL. Male sex, African American race, diabetes, coronary artery disease, and lower estimated glomerular filtration rate were associated significantly with 25(OH)D level <30 ng/mL. A graded increase in risk of 25(OH)D level <30 ng/mL was evident across increasing body mass index levels. Patients who had 25(OH)D levels measured in fall through spring had higher odds for 25(OH)D levels <30 ng/mL. After covariate adjustment, patients with CKD with 25(OH)D levels <15 ng/mL had a 33% increased risk of mortality (95% CI, 1.07-1.65). The group with 25(OH)D levels of 15-29 ng/mL did not show a significantly increased risk of mortality (HR, 1.03; 95% CI, 0.86-1.22) compared with patients with 25(OH)D levels ≥30 ng/mL. LIMITATIONS: Single-center observational study, lack of data for albuminuria and other markers of bone and mineral disorders, and attrition bias. CONCLUSIONS: 25(OH)D level <15 ng/mL was associated independently with all-cause mortality in non-dialysis-dependent patients with CKD. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/21816525/Low_25_hydroxyvitamin_D_levels_and_mortality_in_non_dialysis_dependent_CKD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(11)01007-9 DB - PRIME DP - Unbound Medicine ER -