title: Impact of vitamin A on clinical outcomes in haemodialysis patients.
abstract: BACKGROUND
  Patients on maintenance haemodialysis treatment experience an excessive risk of cardiovascular disease and mortality. The vitamin A concentration is known to be higher in these patients compared to the general population where elevated vitamin A concentrations are associated with adverse outcome. The impact of vitamin A on morbidity and mortality in end-stage renal disease patients is controversial and is the topic of this study.
  
  
  METHODS
  We analysed plasma retinol and retinol-binding protein 4 (RBP4) in 1177 diabetic haemodialysis patients, who participated in the German Diabetes and Dialysis Study (median follow-up 4 years). By Cox regression analyses hazard ratios (HRs) were determined for pre-specified, adjudicated end points according to baseline concentrations.
  
  
  RESULTS
  Patients had a mean age of 66 ± 8 years, mean retinol and RBP4 concentrations of 3.28 (0.71-7.44) and 4.02 (1.28-10.1) μmol/L, respectively. Patients with retinol concentrations in the first quartile (<2.6 μmol/L) had an almost 2-fold increased risk of all-cause mortality compared to patients of the fourth quartile [>3.9 μmol/L; HR 1.81, 95% confidence interval (CI) 1.43-2.30]. There was a strong association between low retinol and the risk of sudden cardiac death (SCD, HR 2.22, 95% CI 1.41-3.50) and fatal infection (HR 2.19, 95% CI 1.26-3.82). Patients with RBP4 concentrations in the lowest quartile (<3.0 μmol/L) were more likely to die of any cause (HR 1.43, 95% CI 1.14-1.80), experience SCD (HR 1.97, 95% CI 1.28-3.03) and cardiovascular events (HR 1.43, 95% CI 1.10-1.85).
  
  
  CONCLUSIONS
  This large cohort study shows a strong association of low retinol and RBP4 concentrations with SCD and all-cause mortality in diabetic haemodialysis patients.
authors.affiliation: Institute of Nutritional Science, University of Potsdam, Potsdam, Germany. espe@uni-potsdam.de
authors.forename: Katharina M
authors.initials: KM
authors.lastname: Espe
authors.forename: Jens
authors.initials: J
authors.lastname: Raila
authors.forename: Andrea
authors.initials: A
authors.lastname: Henze
authors.forename: Vera
authors.initials: V
authors.lastname: Krane
authors.forename: Florian J
authors.initials: FJ
authors.lastname: Schweigert
authors.forename: Berthold
authors.initials: B
authors.lastname: Hocher
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
authors.forename: Christiane
authors.initials: C
authors.lastname: Drechsler
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D014801:Vitamin A / Q000097:blood*
chemical_list: D014801:Vitamin A