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Vitamin D Deficiency, Mortality, and Hospitalization in Hemodialysis Patients with or without Protein-Energy Wasting.
Nephron Clin Pract. 2011 Aug 11;119(3):c220-c226.
Fiedler R, Dorligjav O, Seibert E, Ulrich C, Markau S, Girndt M.
Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany.
Background:Vitamin D deficiency and protein-energy wasting (PEW) are highly prevalent in hemodialysis (HD) patients. The goal of our study was to investigate if a lack of vitamin D influences mortality and hospitalization of HD patients with or without PEW. Methods: In 81 chronic HD patients with different nutritional status assessed by the Malnutrition Inflammation Score (MIS), vitamin D deficiency (25-OH-vitamin D(3) levels ?30 nmol/l or ?12 ng/ml) was prospectively investigated for its prognostic impact on mortality and hospitalization. Over a 3-year follow-up, all-cause mortality and hospitalization were determined. The predictive value of low vitamin D levels and PEW as well as their combined effect were evaluated using a multivariate Cox regression model.
Results: Vitamin D deficiency was frequent in HD patients with and without PEW. It significantly increased mortality rate in HD patients (HR 2.76 (1.33-5.73), p < 0.01), which was aggravated by concomitant PEW (HR 5.88 (2.29-15.09), p < 0.001). The hospitalization rate, however, was not influenced independently by nutritional status.
Conclusions: Low 25-OH-vitamin D(3) concentration is an independent predictor for survival, but not for hospitalization of HD patients. It is not merely a malnutrition-associated finding, although a MIS ?8 further impaired survival prognosis.
Copyright © 2011 S. Karger AG, Basel.
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Anticancer Res. 2012 Jan;32(1):391-5.
Krause R, Schober-Halstenberg HJ, Edenharter G, Haas K, Roth HJ, Frei U.
KfH Nephrological Center Moabit, Turmstr. 20A, 10559 Berlin, Germany. rolfdieter.krause at kfh-dialyse.de
AIM: The goal was to analyze the link between blood levels of calcidiol and all-cause, cardiac and infectious diseases, and mortality due to cancer in hemodialysis patients.
PATIENTS AND METHODS: This study retrospectively evaluated a representative sub-cohort (n=6,518) of German hemodialysis patients from the incidence cohorts 1997-2006.
RESULTS: Most (58.8%) were found to be vitamin D deficient (25(OH)D<20 ng/ml), with 41.2% being severely deficient (25(OH)D<12.5 ng/ml). All-cause mortality risk more than doubled in patients with severe deficiency (adjusted odds ratio (aOR)=2.67; 95% confidence interval (CI)=2.30-3.10; p<0.0001). Comparable data were obtained for mortality from cardiac disease (aOR=1.57; 95% CI=1.30-1.88; p<0.0001), infectious disease (aOR=1.48; 95% CI=1.15-1.90; p=0.0026), and cancer (aOR=1.51; 95% CI=1.09-2.08; p=0.0121), respectively.
CONCLUSION: These data highlight the need to ensure primarily adequate 25(OH)D levels in dialysis patients for an advantage of survival.
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- Overview Kidney and vitamin D
- Kidney failure and vitamin D deficiency vicious cycle – Jan 2011
- Chronic Kidney Disease meta-analysis of vitamin D – Jan 2011
- Kidney and Vitamin D – Heaney Jan 2011
- Even with vitamin D supplementation Kidney transplant patients were deficient – Jan 2011
- Adding Vitamin decreased kidney deaths by 4x – Dec 2010
- It is amazing that such excellent results were buried in the paper. They were not in the title nor abstract.
- This is the result of about 10 trials with about 5,000 kidney disease patients.
- Note: some of the trials were terminated as they felt it morally wrong to not give vitamin D to all of the Kidney patients
- Meta-analysis finds vitamin D helps chronic kidney disease – Sept 2010
- All items in Kidney and Vitamin D 66 items as of Aug 2011
- Vitamin D expanding spectrum - Kidney June 2010
- Review of vitamin D and kidney - June 2010
- Majority of blacks on dialysis were vitamin D deficient - March 2010
- Of 908 dialysis patients: vitamin D deficiency: black women (from 90% to 100%), black men (from 85% to 100%)
- Heart problems 5X worse for chronic kidney patients low on vitamin D – Mar 2011
- CKD patients 40% more likely to die of cardiovasular problems for every 10ng decrease in vitamin D
- Dialysis patients with higher levels of vitamin D were better – May 2011
- Low vitamin D associated with hemodialysis problems – May 2010
- Each 10 ng increase in vitamin D decreased kidney disease death by 14 percent – May 2011 - Meta-analysis