Clinical measures identify vitamin D deficiency in dialysis.
OBJECTIVE
Vitamin D deficiency (defined by serum levels of 25-hydroxyvitamin D) is common in patients with ESRD on hemodialysis, but risk factors are unknown. This study was conducted to determine whether routinely measured clinical and demographic parameters could identify dialysis patients who are vitamin D deficient.


METHODS
Nine-hundred eight patients with 25-hydroxyvitamin D levels were identified from the Accelerated Mortality on Renal Replacement (ArMORR) cohort of incident U.S. dialysis patients and were divided into training (60%) and validation (40%) sets. Predictive models were generated from routinely assessed clinical and demographic data in the training set using logistic regression modeling, neural networks, and decision trees with vitamin D deficiency as the dependent variable. Models underwent progressive variable reduction to identify the simplest model that remained predictive.


RESULTS
Seventy-nine percent of the population was vitamin D deficient (25-hydroxyvitamin D <30 ng/ml). Black race, female sex, winter season, and hypoalbuminemia (serum albumin < or =3.1 g/dl) were the strongest predictors of vitamin D deficiency. In the validation set, the presence of hypoalbuminemia and winter season increased the likelihood of vitamin D deficiency in black women (from 90% to 100%), black men (from 85% to 100%), white women (from 82% to 94%), and white men (from 66% to 92%).


CONCLUSIONS
Deficiency of 25-hydroxyvitamin D is nearly universal among patients with hypoalbuminemia initiating chronic hemodialysis in winter.
Bhan
Ishir
I
Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 750, Boston, MA 02114, USA. ibhan@partners.org
Burnett-Bowie
Sherri-Ann M
SA
Ye
Jun
J
Tonelli
Marcello
M
Thadhani
Ravi
R
D001741:Black or African American; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D003663:Decision Trees; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016571:Neural Networks, Computer; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012621:Seasons; D012737:Sex Factors; D014481:United States; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology; D044465:White People
D015415:Biomarkers; D014807:Vitamin D; C104450:25-hydroxyvitamin D