title: Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients.
abstract: OBJECTIVE
  Dialysis patients experience an excess mortality, predominantly of sudden cardiac death (SCD). Accumulating evidence suggests a role of vitamin D for myocardial and overall health. This study investigated the impact of vitamin D status on cardiovascular outcomes and fatal infections in haemodialysis patients.
  
  
  RESULTS
  25-hydroxyvitamin D [25(OH)D] was measured in 1108 diabetic haemodialysis patients who participated in the German Diabetes and Dialysis Study and were followed up for a median of 4 years. By Cox regression analyses, we determined hazard ratios (HR) for pre-specified, adjudicated endpoints according to baseline 25(OH)D levels: SCD (n = 146), myocardial infarction (MI, n = 174), stroke (n = 89), cardiovascular events (CVE, n = 414), death due to heart failure (n = 37), fatal infection (n = 111), and all-cause mortality (n = 545). Patients had a mean age of 66 ± 8 years (54% male) and median 25(OH)D of 39 nmol/L (interquartile range: 28-55). Patients with severe vitamin D deficiency [25(OH)D of ≤ 25 nmol/L] had a 3-fold higher risk of SCD compared with those with sufficient 25(OH)D levels >75 nmol/L [HR: 2.99, 95% confidence interval (CI): 1.39-6.40]. Furthermore, CVE and all-cause mortality were strongly increased (HR: 1.78, 95% CI: 1.18-2.69, and HR: 1.74, 95% CI: 1.22-2.47, respectively), all persisting in multivariate models. There were borderline non-significant associations with stroke and fatal infection while MI and deaths due to heart failure were not meaningfully affected.
  
  
  CONCLUSIONS
  Severe vitamin D deficiency was strongly associated with SCD, CVE, and mortality, and there were borderline associations with stroke and fatal infection. Whether vitamin D supplementation decreases adverse outcomes requires further evaluation.
authors.affiliation: Department of Internal Medicine 1, Division of Nephrology, University of Würzburg, Oberdürrbacher Str. 6, D-97080 Würzburg, Germany. c.drechsler@gmx.net
authors.forename: Christiane
authors.initials: C
authors.lastname: Drechsler
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.forename: Barbara
authors.initials: B
authors.lastname: Obermayer-Pietsch
authors.forename: Marion
authors.initials: M
authors.lastname: Verduijn
authors.forename: Andreas
authors.initials: A
authors.lastname: Tomaschitz
authors.forename: Vera
authors.initials: V
authors.lastname: Krane
authors.forename: Katharina
authors.initials: K
authors.lastname: Espe
authors.forename: Friedo
authors.initials: F
authors.lastname: Dekker
authors.forename: Vincent
authors.initials: V
authors.lastname: Brandenburg
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.forename: Eberhard
authors.initials: E
authors.lastname: Ritz
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D003925:Diabetic Angiopathies / Q000401:mortality; D003928:Diabetic Nephropathies / Q000401:mortality / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D007239:Infections / Q000097:blood / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000401:mortality; D055815:Young Adult
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D