Low 25-Hydroxyvitamin D Levels and Mortality in Non-Dialysis-Dependent CKD.
Am J Kidney Dis. 2011 Aug 2.
Navaneethan SD, Schold JD, Arrigain S, Jolly SE, Jain A, Schreiber MJ Jr, Simon JF, Srinivas TR, Nally JV Jr.
Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland, OH.
BACKGROUND: Low 25-hydroxyvitamin D (25OHD) 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.
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See also VitaminDWiki
- Overview Kidney and vitamin D
- 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
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- Wearable dialysis device being tested which also converts vitamin D - Mar 2011
- Chronic Kidney Disease meta-analysis of vitamin D – Jan 2011
- Meta-analysis finds vitamin D helps chronic kidney disease – Sept 2010
- Chronic Kidney disease and vitamin D deficiency – Jan 2011
- Use of vitamin D in chronic kidney disease patients. – May 2010
- 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 less of vitamin D
- Virtually all black dialysis patients with low albumin are vitamin D deficient in the winter – Mar 2010
- 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