title: Vitamin D deficiency, mortality, and hospitalization in hemodialysis patients with or without protein-energy wasting.
abstract: BACKGROUND
  Vitamin D deficiency and protein-energy wasting (PEW) are highly prevalent in hemodialysis (HD) patients. The goal of our study was to investigate if a lack of vitamin D influences mortality and hospitalization of HD patients with or without PEW.
  
  
  METHODS
  In 81 chronic HD patients with different nutritional status assessed by the Malnutrition Inflammation Score (MIS), vitamin D deficiency (25-OH-vitamin D(3) levels ≤30 nmol/l or ≤12 ng/ml) was prospectively investigated for its prognostic impact on mortality and hospitalization. Over a 3-year follow-up, all-cause mortality and hospitalization were determined. The predictive value of low vitamin D levels and PEW as well as their combined effect were evaluated using a multivariate Cox regression model.
  
  
  RESULTS
  Vitamin D deficiency was frequent in HD patients with and without PEW. It significantly increased mortality rate in HD patients (HR 2.76 (1.33-5.73), p < 0.01), which was aggravated by concomitant PEW (HR 5.88 (2.29-15.09), p < 0.001). The hospitalization rate, however, was not influenced independently by nutritional status.
  
  
  CONCLUSIONS
  Low 25-OH-vitamin D(3) concentration is an independent predictor for survival, but not for hospitalization of HD patients. It is not merely a malnutrition-associated finding, although a MIS ≥8 further impaired survival prognosis.
authors.affiliation: Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany. roman.fiedler@medizin.uni-halle.de
authors.forename: Roman
authors.initials: R
authors.lastname: Fiedler
authors.forename: Otgontogoo
authors.initials: O
authors.lastname: Dorligjav
authors.forename: Eric
authors.initials: E
authors.lastname: Seibert
authors.forename: Christof
authors.initials: C
authors.lastname: Ulrich
authors.forename: Silke
authors.initials: S
authors.lastname: Markau
authors.forename: Matthias
authors.initials: M
authors.lastname: Girndt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002112:Calcifediol / Q000097:blood*; D002117:Calcitriol / Q000097:blood; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000150:complications*; D006435:Renal Dialysis; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*; D055815:Young Adult
chemical_list: D002117:Calcitriol; D002112:Calcifediol