Journal of Renal Nutrition, Available online 19 July 2013, http://dx.doi.org/10.1053/j.jrn.2013.05.003
Shuchi Anand, MD∗, Corresponding author
Glenn M. Chertow, MD, MPH∗,
Kirsten L. Johansen, MD†, ‡,
Barbara Grimes, PhD§,
Lorien S. Dalrymple, MD, MPH¶,
George A. Kaysen, MD, PhD¶, ∗∗,
Manjula Kurella Tamura, MD, MPH∗, ††
∗ Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
† Nephrology Section, Department of Veterans Affairs Medical Center, San Francisco, California
‡ Division of Nephrology, Department of Medicine, University of California–San Francisco, San Francisco, California
§ Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, California
¶ Division of Nephrology, Department of Medicine, University of California–Davis, Davis, California
∗∗ Nephrology Section, Department of Veterans Affairs Medical Center, Mather, California
†† Department of Veterans Affairs Medical Center, Palo Alto Health Care System, Palo Alto, California
Objective: Although several studies have shown poorer survival among individuals with 25-hydroxy (OH) vitamin D deficiency, data on patients receiving dialysis are limited. Using data from the Comprehensive Dialysis Study (CDS), we tested the hypothesis that patients new to dialysis with low serum concentrations of 25-OH vitamin D would experience higher mortality and hospitalizations.
Design: The CDS is a prospective cohort study.We recruited participants from 56 dialysis units located throughout the United States.
Subjects and Intervention: We obtained data on demographics, comorbidites, and laboratory values from the CDS Patient Questionnaire as well as the Medical Evidence Form (CMS form 2728). Participants provided baseline serum samples for 25-OH vitamin D measurements.
Main Outcome Measure: We ascertained time to death and first hospitalization as well as number of first-year hospitalizations via the U.S. Renal Data System standard analysis files. We used Cox proportional hazards to determine the association between 25-OH vitamin D tertiles and survival and hospitalization. For number of hospitalizations in the first year, we used negative binomial regression.
Results: The analytic cohort was composed of 256 patients with Patient Questionnaire data and 25-OH vitamin D concentrations. The mean age of participants was 62 (±14.0) years, and mean follow-up was 3.8 years. Patients with 25-OH vitamin D concentrations in the lowest tertile (<10.6 ng/mL) at the start of dialysis experienced higher mortality (adjusted hazard ratio 1.75, 95% confidence interval [CI] 1.03-2.97) as well as hospitalization (adjusted hazard ratio 1.76, 95% CI 1.24-2.49). Patients in the lower 2 tertiles (<15.5 ng/mL) experienced a higher rate of hospitalizations in the first year (incidence rate ratio 1.70 [95% CI 1.06-2.72] for middle tertile, 1.66 [95% CI 1.10-2.51] for lowest tertile).
Conclusion: We found a sizeable increase in mortality and hospitalization for patients on dialysis with severe 25-OH vitamin D deficiency.
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