Vitamin D Deficiency in Dialysis Patients: Effect of Dialysis Modality and Implications on Outcome
published online 31 May 2010. Corrected Proof
Objective
Vitamin D deficiency has been linked to cardiovascular disease and mortality in hemodialysis (HD) patients. The purpose of the present cross-sectional study was to analyze the Vitamin D status of dialysis patients from a single center, study determinants of Vitamin D deficiency, and assess its implications on outcome.
Methods
A prospective observational study of 115 prevalent dialysis patients was carried out, in which clinical and dialysis-related characteristics including routine biochemistry were studied in relation to levels of 25-hydroxyvitamin-D (25[OH]D, chemiluminescence). Survival was assessed after a median follow-up period of 413 days.
Results
25(OH)D deficiency and insufficiency was present in 51% and 42% of the patients, respectively. Only 7% of the patients showed normal 25(OH)D levels. Peritoneal dialysis patients presented the lowest 25(OH)D levels. Also, a significant difference was found between on-line hemodiafiltration (OL-HDF) and conventional HD (11 [6 to 16] versus 19 [13 to 27] ng/mL; P < 0.001; 25th to 75th percentiles, conventional HD versus OL-HDF respectively). In multinomial logistic regression analysis, patients on conventional HD had 8.35 greater odds (95% CI [2.04 to 34.20]) of 25(OH)D deficiency than OL-HDF even after adjustment for sex, parathyroid hormone, pH, and Charlson comorbidity index. During the follow-up period, 18 patients died. Both crude and adjusted (hazard ratio, 6.96; 95% CI [1.44 to 33.64]) Cox analysis identified 25(OH)D deficiency as a mortality risk factor.
Conclusion
This observational study underlines the high prevalence of hypovitaminosis D in dialysis patients and its strong implications on outcome. Furthermore, our results suggest that OL-HDF was associated with a better preservation of the vitamin D status as compared with conventional HD.
∗Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
†Division of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden
‡Centre for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
§Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
Address reprint requests to Juan Jesús Carrero, PhD Pharm, PhD Med, K56, Division of Renal Medicine and Baxter Novum, CLINTEC, Karolinska University Hospital at Huddinge, 14186 Stockholm, Sweden.
BL is employed by Baxter Healthcare Inc. None of the other authors have any other conflict of interest.
ABSTRACT