Vitamin D levels and patient outcome in chronic kidney disease.
Vitamin D deficiency has been linked to cardiovascular disease and early mortality in patients on hemodialysis; however, it is not known if the same association exists at earlier stages of chronic kidney disease. To determine this we enrolled 168 consecutive new referrals to a chronic kidney disease clinic over a 2 year period and followed them for up to 6 years. All patients were clinically stable and had an estimated glomerular filtration rate (eGFR) at stage 2 or less and were without an imminent need for dialysis. Baseline 25-hydroxyvitamin D levels directly and significantly correlated with eGFR. After an average follow-up of 48 months, 48 patients started dialysis and 78 had died. In crude analyses, 25-hydroxyvitamin D predicted both time to death and end-stage renal disease. A dual-event Cox's model confirmed 25-hydroxyvitamin D as an independent predictor of study outcomes when adjusted for age, heart failure, smoking, C-reactive protein, albumin, phosphate, use of converting enzyme inhibitors or angiotensin receptor blockers, and eGFR. Our study shows that plasma 25-hydroxyvitamin D is an independent inverse predictor of disease progression and death in patients with stage 2-5 chronic kidney disease.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Pietro
P
Ravani
Fabio
F
Malberti
Giovanni
G
Tripepi
Paola
P
Pecchini
Sebastiano
S
Cutrupi
Patrizia
P
Pizzini
Francesca
F
Mallamaci
Carmine
C
Zoccali
D002908:Chronic Disease; D018450:Disease Progression; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood*
D014807:Vitamin D