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2.4 times more likely to die if have Chronic Kidney Disease and low vitamin D - Sept 2016

What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

World J Nephrol. 2016 Sep 6;5(5):471-481. DOI: 10.5527/wjn.v5.i5.471
Molina P1, Górriz JL1, Molina MD1, Beltrán S1, Vizcaíno B1, Escudero V1, Kanter J1, Ávila AI1, Bover J1, Fernández E1, Nieto J1, Cigarrán S1, Gruss E1, Fernández-Juárez G1, Martínez-Castelao A1, Navarro-González JF1, Romero R1, Pallardó LM1.
1Pablo Molina, Sandra Beltrán, Belén Vizcaíno, Verónica Escudero, Julia Kanter, Ana I Ávila, José L Górriz, Luis M Pallardó, Department of Nephrology, Dr Peset University Hospital, 46017 Valencia, Spain.

CKD death vs Vitamin D

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CKD Hospitalizations vs Vitamin D

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AIM:
To evaluate thresholds for serum 25(OH)D concentrations in relation to death, kidney progression and hospitalization in non-dialysis chronic kidney disease (CKD) population.

METHODS:
Four hundred and seventy non-dialysis 3-5 stage CKD patients participating in OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into 3 groups according to 25(OH)D levels at enrollment (less than 20 ng/mL, between 20 and 29 ng/mL, and at or above 30 ng/mL), considering 25(OH)D between 20 and 29 ng/mL as reference group. Association between 25(OH)D levels and death (primary outcome), and time to first hospitalization and renal progression (secondary outcomes) over a 3-year follow-up, were assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. To identify 25(OH)D levels at highest risk for outcomes, receiver operating characteristic (ROC) curves were performed.

RESULTS:
Over 29 ± 12 mo of follow-up, 46 (10%) patients dead, 156 (33%) showed kidney progression, and 126 (27%) were hospitalized. After multivariate adjustment, 25(OH)D < 20 ng/mL was an independent predictor of

  • all-cause mortality (HR = 2.33; 95%CI: 1.10-4.91; P = 0.027) and
  • kidney progression (HR = 2.46; 95%CI: 1.63-3.71; P < 0.001),

whereas the group with 25(OH)D at or above 30 ng/mL did not have a different hazard for outcomes from the reference group. Hospitalization outcomes were predicted by 25(OH) levels (HR = 0.98; 95%CI: 0.96-1.00; P = 0.027) in the unadjusted Cox proportional hazards model, but not after multivariate adjusting. ROC curves identified 25(OH)D levels at highest risk for death, kidney progression, and hospitalization, at 17.4 ng/mL [area under the curve (AUC) = 0.60; 95%CI: 0.52-0.69; P = 0.027], 18.6 ng/mL (AUC = 0.65; 95%CI: 0.60-0.71; P < 0.001), and 19.0 ng/mL (AUC = 0.56; 95%CI: 0.50-0.62; P = 0.048), respectively.

CONCLUSION:
25(OH)D < 20 ng/mL was an independent predictor of death and progression in patients with stage 3-5 CKD, with no additional benefits when patients reached the levels at or above 30 ng/mL suggested as optimal by CKD guidelines.

PMID: 27648411

Attached files

ID Name Comment Uploaded Size Downloads
12710 Hospitalization Kidney.jpg admin 02 Oct, 2019 29.86 Kb 467
7094 CKD death.jpg admin 21 Sep, 2016 17.87 Kb 1034
7093 Optimal CKD.pdf admin 21 Sep, 2016 2.34 Mb 626