Nephrol Dial Transplant. 2011 Mar 4
Pilz S, Tomaschitz A, Friedl C, Amrein K, Drechsler C, Ritz E, Boehm BO, Grammer TB, März W.
1Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria.
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/1.73m(2). 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/1.73m(2) 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. PMID: 21378153
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