2.4 times more likely to die if have Chronic Kidney Disease and low vitamin D - Sept 2016

What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

World J Nephrol. 2016 Sep 6;5(5):471-481. DOI: 10.5527/wjn.v5.i5.471
Molina P1, Górriz JL1, Molina MD1, Beltrán S1, Vizcaíno B1, Escudero V1, Kanter J1, Ávila AI1, Bover J1, Fernández E1, Nieto J1, Cigarrán S1, Gruss E1, Fernández-Juárez G1, Martínez-Castelao A1, Navarro-González JF1, Romero R1, Pallardó LM1.
1Pablo Molina, Sandra Beltrán, Belén Vizcaíno, Verónica Escudero, Julia Kanter, Ana I Ávila, José L Górriz, Luis M Pallardó, Department of Nephrology, Dr Peset University Hospital, 46017 Valencia, Spain.

CKD death vs Vitamin D

CKD Hospitalizations vs Vitamin D

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AIM:
To evaluate thresholds for serum 25(OH)D concentrations in relation to death, kidney progression and hospitalization in non-dialysis chronic kidney disease (CKD) population.

METHODS:
Four hundred and seventy non-dialysis 3-5 stage CKD patients participating in OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into 3 groups according to 25(OH)D levels at enrollment (less than 20 ng/mL, between 20 and 29 ng/mL, and at or above 30 ng/mL), considering 25(OH)D between 20 and 29 ng/mL as reference group. Association between 25(OH)D levels and death (primary outcome), and time to first hospitalization and renal progression (secondary outcomes) over a 3-year follow-up, were assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. To identify 25(OH)D levels at highest risk for outcomes, receiver operating characteristic (ROC) curves were performed.

RESULTS:
Over 29 ± 12 mo of follow-up, 46 (10%) patients dead, 156 (33%) showed kidney progression, and 126 (27%) were hospitalized. After multivariate adjustment, 25(OH)D < 20 ng/mL was an independent predictor of

• all-cause mortality (HR = 2.33; 95%CI: 1.10-4.91; P = 0.027) and
• kidney progression (HR = 2.46; 95%CI: 1.63-3.71; P < 0.001),

whereas the group with 25(OH)D at or above 30 ng/mL did not have a different hazard for outcomes from the reference group. Hospitalization outcomes were predicted by 25(OH) levels (HR = 0.98; 95%CI: 0.96-1.00; P = 0.027) in the unadjusted Cox proportional hazards model, but not after multivariate adjusting. ROC curves identified 25(OH)D levels at highest risk for death, kidney progression, and hospitalization, at 17.4 ng/mL [area under the curve (AUC) = 0.60; 95%CI: 0.52-0.69; P = 0.027], 18.6 ng/mL (AUC = 0.65; 95%CI: 0.60-0.71; P < 0.001), and 19.0 ng/mL (AUC = 0.56; 95%CI: 0.50-0.62; P = 0.048), respectively.

CONCLUSION:
25(OH)D < 20 ng/mL was an independent predictor of death and progression in patients with stage 3-5 CKD, with no additional benefits when patients reached the levels at or above 30 ng/mL suggested as optimal by CKD guidelines.

PMID: 27648411