1Department of Clinical Epidemiology Leiden University Medical Center, Leiden, The Netherlands.
Nephrol Dial Transplant. 2011 Mar;26(3):1024-32. doi: 10.1093/ndt/gfq606. Epub 2010 Oct 14.
The majority of dialysis patients suffer from vitamin D deficiency, which might contribute to an adverse health outcome. We aimed to elucidate whether European dialysis patients with low 25-hydroxyvitamin D (25(OH)D) levels are at increased risk of mortality and specific fatal events.
This was a prospective cohort study of incident dialysis patients in the Netherlands (the NECOSAD). We selected all patients with measured 25(OH)D at 12 months after the start of dialysis, the baseline for our study. By Cox regression analyses, we assessed the impact of 25(OH)D levels on short-term (6 months of follow-up) as well as longer-term mortality (3 years of follow-up). Associations of 25(OH)D levels with cardiovascular and non-cardiovascular mortality were also determined.
The data from 762 patients (39% females, age 59 ± 15 years, 25(OH)D = 18 ± 11 ng/mL) were available. Fifty-one and 213 patients died during a follow-up of 6 months and 3 years, respectively. After adjustments for possible confounders, the hazard ratio (HR) (with 95% CI) for mortality was 2.0 (1.0-3.8) for short-term and 1.5 (1.0-2.1) for longer-term mortality when comparing patients with 25(OH)D levels ≤ 10 ng/mL with those presenting with 25(OH)D levels > 10 ng/mL. Adjusted HRs for cardiovascular mortality were 2.7 (1.1-6.5) and 1.7 (1.1-2.7) for short- and longer-term mortality, respectively. For non-cardiovascular mortality, we observed no relevant association overall. The impact of 25(OH)D levels on clinical events was modified by parathyroid hormone (PTH) status, with low 25(OH)D levels meaningfully affecting outcomes only in patients with PTH levels above the median of 123 pmol/L.
Vitamin D deficiency in dialysis patients is associated with an adverse health outcome, in particular with short-term cardiovascular mortality. Intervention studies are urgently needed to evaluate whether vitamin D supplementation improves health outcomes of dialysis patients.
大多数透析患者患有维生素 D 缺乏症，这可能导致不良健康后果。我们旨在阐明欧洲透析患者低 25-羟维生素 D（25（OH）D）水平是否会增加死亡和特定致命事件的风险。
这是荷兰（NECOSAD）透析患者的前瞻性队列研究。我们选择了在透析开始后 12 个月测量 25（OH）D 的所有患者作为本研究的基线。通过 Cox 回归分析，我们评估了 25（OH）D 水平对短期（6 个月随访）和长期死亡率（3 年随访）的影响。还确定了 25（OH）D 水平与心血管和非心血管死亡率的关系。
762 名患者（39%为女性，年龄 59±15 岁，25（OH）D=18±11ng/mL）的数据可用。51 名和 213 名患者分别在 6 个月和 3 年随访期间死亡。在调整可能的混杂因素后，25（OH）D 水平≤10ng/mL 的患者与 25（OH）D 水平>10ng/mL 的患者相比，短期和长期死亡率的死亡风险比（HR）（95%CI）分别为 2.0（1.0-3.8）和 1.5（1.0-2.1）。心血管死亡率的调整 HR 分别为短期和长期死亡率的 2.7（1.1-6.5）和 1.7（1.1-2.7）。对于非心血管死亡率，总体上没有观察到相关关联。25（OH）D 水平对临床事件的影响受甲状旁腺激素（PTH）状态的修饰，只有当 PTH 水平高于 123pmol/L 的中位数时，低 25（OH）D 水平才会显著影响结果。
透析患者维生素 D 缺乏与不良健康后果相关，特别是与短期心血管死亡率相关。迫切需要干预研究来评估维生素 D 补充是否能改善透析患者的健康结局。
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