title: Vitamin D deficiency is an independent predictor of anemia in end-stage heart failure.
abstract: Both, anemia and vitamin D deficiency are prevalent in patients with heart failure. According to recent evidence, vitamin D may stimulate erythropoiesis. We measured circulating 25-hydroxyvitamin D (25[OH]D), 1,25-dihydroxyvitamin D (1,25[OH](2)D) and hemoglobin (Hb) in a cross-sectional study in 364 end-stage heart failure patients awaiting cardiac transplantation, of whom 52.6% met the criteria for anemia (Hb < 13 g/dl in males and <12 g/dl in females). None of the patients were on erythrocyte-stimulating agents. Of the study cohort, 87.8% had 25(OH)D concentrations below 50 nmol/l. The mean Hb concentrations were significantly reduced in the lower tertiles of 25(OH)D and 1,25(OH)(2)D (P < 0.001). In multivariate-adjusted logistic regression analyses, the odds ratios for anemia of the lowest tertile of 25(OH)D (<18 nmol/l) and 1,25(OH)(2)D (<40 pmol/l) were 2.69 (1.46-5.00) and 4.08 (2.18-7.62) compared with their respective highest tertile (>32 nmol/l and >70 pmol/l). Patients with severe dual deficiency of 25(OH)D and 1,25(OH)(2)D had an odds ratio for anemia of 9.87 (95% CI 3.59-27.1) compared with patients in the highest tertile for both vitamin D metabolites. Circulating 1,25(OH)(2)D was directly related to circulating 25(OH)D levels and kidney function (P < 0.001), and inversely associated with C-reactive protein (P = 0.020). Our data demonstrate that vitamin D deficiency is independently associated with low Hb values and anemia in end-stage heart failure. Circulating 1,25(OH)(2)D is a better predictor of anemia than circulating 25(OH)D. Prospective randomized studies with administration of vitamin D (metabolites) will have to clarify if the association of vitamin D deficiency with anemia is causal.
authors.affiliation: Department of Cardio-Thoracic Surgery, Heart Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany. azittermann@hdz-nrw.de
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.forename: Antje
authors.initials: A
authors.lastname: Jungvogel
authors.forename: Sylvana
authors.initials: S
authors.lastname: Prokop
authors.forename: Joachim
authors.initials: J
authors.lastname: Kuhn
authors.forename: Jens
authors.initials: J
authors.lastname: Dreier
authors.forename: Uwe
authors.initials: U
authors.lastname: Fuchs
authors.forename: Uwe
authors.initials: U
authors.lastname: Schulz
authors.forename: Jan F
authors.initials: JF
authors.lastname: Gummert
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology*; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D006454:Hemoglobins; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D; D002097:C-Reactive Protein; C104450:25-hydroxyvitamin D