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Death rate increased 3X for chronic kidney disease if low vitamin D – Nov 2011

Vitamin D status and mortality in chronic kidney disease

Nephrol. Dial. Transplant. (2011) 26 (11): 3603-3609. doi: 10.1093/ndt/gfr076
Stefan Pilz 1,2, Andreas Tomaschitz1, Claudia Friedl3, Karin Amrein1, Christiane Drechsler4, Eberhard Ritz5, Bernhard O. Boehm6, Tanja B. Grammer7,8,9 and Winfried März7,8,9
1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
2 Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
3Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
4 Department of Medicine, Division of Nephrology, University of Würzburg, Würzburg, Germany
5 Department of Nephrology, University of Heidelberg, Heidelberg, Germany
6 Division of Endocrinology and Diabetes, Center for Internal Medicine, University Medical Center Ulm, Ulm, Germany
7 Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Rupertus Carola University Heidelberg, Mannheim, Germany
8 Synlab Center of Laboratory Diagnostics, Heidelberg, Germany
9 Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
Correspondence and offprint requests to: Stefan Pilz; E-mail: stefan.pilz at chello.at
Received December 6, 2010, Accepted January 25, 2011.

Background. Vitamin D deficiency is found in the majority of patients with chronic kidney disease (CKD) and may contribute to various chronic diseases. Current guidelines suggest correcting reduced 25-hydroxyvitamin D [25(OH)D] concentrations in CKD patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2. Whether low 25(OH)D levels in these patients are associated with higher mortality is unclear. This issue was addressed in the present work.

Methods. We examined 444 patients with eGFR <60 mL/min/1.73m2 from the Ludwigshafen Risk and Cardiovascular Health Study. This prospective cohort study includes Caucasian patients without primary kidney disease who were routinely referred to coronary angiography at baseline (1997–2000).

Results. During a median follow-up time of 9.4 years, 227 patients died including 159 deaths from cardiovascular causes.

Multivariate adjusted hazard ratios (HRs) (with 95% confidence intervals) in severely vitamin D-deficient [25(OH)D <10 ng/mL] compared to vitamin D-sufficient patients [25(OH)D ?30 ng/mL] were 3.79 (1.71–8.43) for all-cause and 5.61 (1.89–16.6) for cardiovascular mortality.

Adjusted HRs per 10 ng/mL increase in 25(OH)D levels were 0.63 (0.50–0.79) for all-cause and 0.59 (0.45–0.79) for cardiovascular mortality. There was no significant interaction with parathyroid hormone concentrations.

Conclusions. Low 25(OH)D levels are associated with increased all-cause and cardiovascular mortality in CKD patients. These findings support suggestions to correct vitamin D deficiency, but whether vitamin D supplementation improves survival remains to be proven in randomized controlled trials.
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