血清 25-羟维生素 D 与慢性肾脏病患者心血管和全因死亡率的关系：NHANES 2007-2018 年结果。

Association of serum 25-hydroxyvitamin D with cardiovascular and all-cause mortality in patients with chronic kidney disease: NHANES 2007‒2018 results.

机构信息

Department of Nephrology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No. 1 People's Hospital, Jiujiang, China.

The Third Unit, The Department of Hepatology. Beijing Youan Hospital, Capital Medical University, Beijing, China; Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.

出版信息

Clinics (Sao Paulo). 2024 Jul 10;79:100437. doi: 10.1016/j.clinsp.2024.100437. eCollection 2024.

DOI:10.1016/j.clinsp.2024.100437

PMID:38996723

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11296000/

Abstract

BACKGROUND

Vitamin D insufficiency is a prevalent issue in patients suffering from CKD. The purpose of this study was to determine whether serum 25(OH)D levels are associated with all-cause and cardiovascular mortality in patients with CKD.

METHODS

To examine the associations between 25(OH)D levels and cardiovascular mortality, this retrospective cohort study used the National Health and Nutrition Examination Survey (NHANES) and the National Death Index (NDI) 2007‒2018 database. A total of 2,668 eligible subjects were included in this study, with follow-up conducted until December 31, 2019. The associations were assessed using Cox proportional hazards regression, restricted cubic splines, Kaplan-Meier survival curves, and competing risks survival analysis. Furthermore, subgroup and sensitivity analyses were performed.

RESULTS

During a median follow-up of 72 months in a weighted population of 11,715,452 eligible participants, there were 665 deaths from any cause, including 196 cardiovascular-related deaths. After adjusting for covariates, lower levels of 25(OH)D were significantly associated with increased risks for both all-cause mortality (HR= 0.85, 95 % CI 0.77∼0.94) and cardiovascular mortality (SHR= 0.80, 95 % CI 0.67∼0.94). Consistent results were also observed when analyzing 25(OH)D as a categorical variable (quartile). Compared to group Q1, both group Q3 (HR = 0.71, 95 % CI 0.54‒0.93) and group Q4 (HR = 0.72, 95 % CI 0.55‒0.94) exhibited a significantly reduced mortality risk. Weighted restricted cubic splines revealed an inverse J-shaped linear association between levels of 25(OH) D and all-cause mortality ((PNonliner > 0.05). Subgroup analysis and sensitivity analysis yielded similar findings.

CONCLUSIONS

All-cause mortality and cardiovascular disease-related mortality were significantly increased by lower 25(OH)D levels, both as continuous and categorical variables. 25(OH)D has an inverse J-shaped linear association with all-cause and cardiovascular mortality.

摘要

背景

维生素 D 不足是 CKD 患者普遍存在的问题。本研究旨在确定血清 25（OH）D 水平与 CKD 患者的全因和心血管死亡率是否相关。

方法

为了研究 25（OH）D 水平与心血管死亡率之间的关系，本回顾性队列研究使用了 2007 年至 2018 年国家健康和营养检查调查（NHANES）和国家死亡指数（NDI）数据库。共纳入 2668 名符合条件的受试者，随访至 2019 年 12 月 31 日。使用 Cox 比例风险回归、限制立方样条、Kaplan-Meier 生存曲线和竞争风险生存分析评估关联。此外，还进行了亚组和敏感性分析。

结果

在加权人口 11715452 名符合条件的参与者中，中位数随访 72 个月期间，共有 665 人死于任何原因，其中 196 人死于心血管相关原因。调整协变量后，较低的 25（OH）D 水平与全因死亡率（HR=0.85，95%CI 0.77~~0.94）和心血管死亡率（SHR=0.80，95%CI 0.67~~0.94）的风险增加显著相关。当分析 25（OH）D 作为分类变量（四分位）时，也观察到了一致的结果。与 Q1 组相比，Q3 组（HR=0.71，95%CI 0.54~~0.93）和 Q4 组（HR=0.72，95%CI 0.55~~0.94）的死亡率风险均显著降低。加权限制立方样条显示，25（OH）D 水平与全因死亡率之间呈负 J 形线性关联（（PNonliner>0.05）。亚组分析和敏感性分析得出了类似的结果。