Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany.
Nephron Clin Pract. 2011;119(3):c220-6. doi: 10.1159/000328927. Epub 2011 Aug 11.
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.
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.
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.
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.
维生素 D 缺乏和蛋白质-能量消耗（PEW）在血液透析（HD）患者中非常普遍。我们的研究目的是探讨维生素 D 缺乏是否会影响伴有或不伴有 PEW 的 HD 患者的死亡率和住院率。
在 81 名接受不同营养状况评估的慢性 HD 患者中，采用营养不良炎症评分（MIS）评估，前瞻性研究维生素 D 缺乏（25-OH-维生素 D（3）水平≤30 nmol/L 或≤12 ng/ml）对死亡率和住院率的预后影响。在 3 年的随访期间，确定全因死亡率和住院率。使用多变量 Cox 回归模型评估低维生素 D 水平和 PEW 及其联合作用的预测价值。
维生素 D 缺乏在伴有和不伴有 PEW 的 HD 患者中很常见。它显著增加了 HD 患者的死亡率（HR 2.76（1.33-5.73），p <0.01），同时伴有 PEW 时死亡率进一步增加（HR 5.88（2.29-15.09），p <0.001）。然而，营养状况不能独立影响住院率。
低 25-OH-维生素 D（3）浓度是 HD 患者生存的独立预测因素，但不是住院的独立预测因素。尽管 MIS≥8 进一步降低了生存预后，但它不仅仅是一种与营养不良相关的发现。
