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.

PMID: 21816525
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