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@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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See also VitaminDWiki

• Google search of VitaminDWiki for Stefan Pilz 9 items as of Nov 2011
• Overview Kidney and vitamin D
• Dialysis patients with low vitamin D were 2.7 X more likely to die of heart problems – Feb 2011
• Kidney failure and vitamin D deficiency vicious cycle – Jan 2011
• Chronic Kidney Disease meta-analysis of vitamin D – Jan 2011
• Kidney and Vitamin D – Heaney Jan 2011
• Even with vitamin D supplementation Kidney transplant patients were deficient – Jan 2011
• Adding Vitamin decreased kidney deaths by 4x – Dec 2010
  • It is amazing that such excellent results were buried in the paper. They were not in the title nor abstract.
  • This is the result of about 10 trials with about 5,000 kidney disease patients.
  • Note: some of the trials were terminated as they felt it morally wrong to not give vitamin D to all of the Kidney patients
• All items in Kidney and Vitamin D 71 items as of Nov 2011
• Heart problems 5X worse for chronic kidney patients low on vitamin D – Mar 2011
  • CKD patients 40% more likely to die of cardiovascular problems for every 10ng decrease in vitamin D
• Dialysis patients with higher levels of vitamin D were better – May 2011
• Blacks have low vitamin D and have 50 percent more kidney failure – Sept 2011 - Meta-analysis
• 33 percent more likely to die of kidney disease if less than 15 ng vitamin D – Aug 2011
• 2.8X more likely to die of hemodialysis if low on vitamin D – Aug 2011
• Some form of vitamin D may be the lowest cost treatment for CKD – Spanish Sept 2011
• Each 10 ng increase in vitamin D decreased kidney disease death by 14 percent – May 2011 also by Stefan Pilz, has the following graph