Inaguma Daijo, Nagaya Hiroshi, Hara Kazuhiro, Tatematsu Miho, Shinjo Hibiki, Suzuki Sachiyo, Mishima Tomoko, Kurata Kei
Department of Nephrology and Rheumatology, Tosei General Hospital, Nishioiwake-cho 160, Seto, Aichi, 489-8642, Japan.
Clin Exp Nephrol. 2008 Apr;12(2):126-131. doi: 10.1007/s10157-007-0023-4. Epub 2008 Jan 9.
It is known that vitamin D has many functions besides involvement in calcium metabolism. It has recently been recognized that vitamin D deficiency is associated with mortality, especially in cardiovascular disease (CVD). Vitamin D deficiency is common in end-stage renal disease, but develops from the early stage of chronic kidney disease (CKD). So we investigated whether the serum level of the activated form of vitamin D (1,25-dihydroxyvitamin D) affected mortality in patients with CKD stages 3 and 4.
Between January 1, 1995, and June 30, 2006 we measured serum 1,25-dihydroxyvitamin D In 226 patients with CKD stages 3 and 4 and classified the results into two groups depending on whether the level was below (group I) or above (group II) 20 pg/ml. We ended the follow-up period on December 31, 2006. We compared all-cause and cardiovascular mortality between the two groups. We also examined predictors of mortality by using Cox proportional regression analysis.
Two-hundred and twenty-six patients (67 men and 159 women, mean age 67.0) were registered in this study, and groups 1 and 2 comprised 84 and 142 patients, respectively. During the follow-up period 43 patients died. CVD was the major cause of death, followed by infectious disease. The Kaplan-Meier survival curve revealed that all-cause mortality was significantly higher in group I, but a significant difference between CVD mortality in the two groups was not demonstrated. By Cox proportional regression analysis, group I was related to all-cause mortality, but this was not proved to be an independent predictor.
The results suggested that serum level of 1,25-dihydroxyvitamin D was associated with all-cause mortality in patients with CKD stages 3 and 4.
众所周知，维生素D除了参与钙代谢外还有许多功能。最近人们认识到维生素D缺乏与死亡率相关，尤其是在心血管疾病（CVD）方面。维生素D缺乏在终末期肾病中很常见，但在慢性肾脏病（CKD）早期就已出现。因此，我们研究了维生素D的活化形式（1,25 - 二羟基维生素D）的血清水平是否会影响3期和4期CKD患者的死亡率。
在1995年1月1日至2006年6月30日期间，我们测量了226例3期和4期CKD患者的血清1,25 - 二羟基维生素D，并根据该水平是否低于（I组）或高于（II组）20 pg/ml将结果分为两组。我们于2006年12月31日结束随访期。我们比较了两组的全因死亡率和心血管死亡率。我们还使用Cox比例回归分析检查了死亡率的预测因素。
本研究登记了226例患者（67例男性和159例女性，平均年龄67.0岁），I组和II组分别包括84例和142例患者。在随访期间，43例患者死亡。CVD是主要死因，其次是传染病。Kaplan - Meier生存曲线显示，I组的全因死亡率显著更高，但两组之间的CVD死亡率未显示出显著差异。通过Cox比例回归分析，I组与全因死亡率相关，但未被证明是独立的预测因素。
结果表明，1,25 - 二羟基维生素D的血清水平与3期和4期CKD患者的全因死亡率相关。
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