Vitamin D deficiency is associated with mortality and adverse vascular access outcomes in patients with end-stage renal disease.
Vitamin D deficiency is associated with mortality and adverse vascular access outcomes in patients with end-stage renal disease.
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维生素 D 缺乏与终末期肾病患者的死亡率和不良血管通路结果相关。
DOI：
10.1016/j.jvs.2014.01.037
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发表时间：
2014
影响因子：
4.3
通讯作者：
Owens,ChristopherD
中科院分区：
文献类型：
--
作者：
Walker,JoyP;Hiramoto,JadeS;Gasper,WarrenJ;Auyang,Philip;Conte,MichaelS;Rapp,JosephH;Lovett,DavidH;Owens,ChristopherD
背景流行病学研究表明，血浆 25 羟基胆钙化醇（维生素 D）缺乏与不良心血管结局相关。慢性肾病与 1α-羟化酶的丧失以及由此导致的维生素 D 缺乏有关。我们假设维生素 D 缺乏与因终末期肾病接受永久性血管通路的患者死亡率增加和血管通路失败增加相关。方法这项回顾性队列研究分析了 2003 年至 2012 年间接受永久性血管通路手术的 128 名患者，同时也获得了这些患者的血浆维生素 D 水平。 <20 ng/mL 的水平被认为是不足的。采用多变量分析来确定维生素 D 与死亡率和血管通路结果之间的关联。结果平均年龄为 66.7 岁，96.8% 为男性，32.0% 为非裔美国人，60.9% 患有糖尿病。在整个队列中，55.5% 的人缺乏维生素 D，尽管维生素 D 缺乏组和非缺乏组的补充率相似。在中位随访 2.73 年期间，有 40 人死亡 (31%)。维生素 D 缺乏的患者往往更年轻 (P= .01)，总胆固醇 (P= .001) 较高，白蛋白 (P= .017) 和钙 (P= .007) 水平较低。尽管年龄较小，但维生素 D 缺乏组的死亡率显着较高 (P= .026)，血管通路失败率也更高 (P= .008)。多变量逻辑回归分析发现维生素 D 缺乏（比值比 [OR]，3.64；95% 置信区间 [CI]，1.12-11.79；P= .031）、通过中心导管进行血液透析（OR，3.08；95% CI，1.04-9.12；P= .042）、冠状动脉疾病（OR，3.08；95% CI， 1.06-8.94；P= .039）、年龄增加（OR，1.09；95% CI，1.03-1.15；P= .001）和白蛋白（OR，0.27；95% CI，0.09-0.83；P= .023）仍然是死亡率的独立预测因子。维生素 D 缺乏（风险比 [HR]，2.34；95% CI，1.17-4.71；P= .02）、合成移植物（HR，3.50；95% CI，1.38-8.89；P= .009）和高脂血症（HR，0.42；95% CI，0.22-0.81；P= .01) 是 Cox 比例风险模型中血管通路失败的独立预测因子。结论 维生素 D 缺乏症在接受血管通路手术的患者中非常普遍。缺乏维生素 D 的患者生存率较差，血管通路结果也较差。需要进一步研究来评估积极补充维生素 D 是否会改善该人群的预后。
BackgroundPlasma 25 hydroxycholecalciferol (vitamin D) deficiency has been associated with adverse cardiovascular outcomes in epidemiologic studies. Chronic kidney disease is associated with loss of 1α-hydroxylase and consequently vitamin D deficiency. We hypothesized that vitamin D deficiency was associated with increased mortality and increased vascular access failure in patients undergoing permanent vascular access for end-stage renal disease.MethodsThis retrospective cohort study analyzed 128 patients undergoing permanent vascular access surgery between 2003 and 2012 for whom concurrent plasma vitamin D levels were also available. Levels were considered deficient at <20 ng/mL. Multivariable analysis was used to determine the association between vitamin D and mortality and vascular access outcomes.ResultsThe mean age was 66.7 years, 96.8% were male, 32.0% were African American, and 60.9% had diabetes mellitus. In the entire cohort, 55.5% were vitamin D-deficient, despite similar rates of repletion among the vitamin D-deficient and nondeficient groups. During a median follow-up of 2.73 years, there were 40 deaths (31%). Vitamin D-deficient patients tended to be younger (P= .01) and to have higher total cholesterol (P= .001) and lower albumin (P= .017) and calcium (P= .007) levels. Despite their younger age, mortality was significantly higher (P= .026) and vascular access failure was increased (P= .008) in the vitamin D-deficient group. Multivariate logistic regression analysis found vitamin D deficiency (odds ratio [OR], 3.64; 95% confidence interval [CI], 1.12-11.79;P= .031), hemodialysis through a central catheter (OR, 3.08; 95% CI, 1.04-9.12;P= .042), coronary artery disease (OR, 3.08; 95% CI, 1.06-8.94;P= .039), increased age (OR, 1.09; 95% CI, 1.03-1.15;P= .001), and albumin (OR, 0.27; 95% CI, 0.09-0.83;P= .023) remained independent predictors of mortality. Vitamin D deficiency (hazard ratio [HR], 2.34; 95% CI, 1.17-4.71;P= .02), a synthetic graft (HR, 3.50; 95% CI, 1.38-8.89;P= .009), and hyperlipidemia (HR, 0.42; 95% CI, 0.22-0.81;P= .01) were independent predictors of vascular access failure in a Cox proportional hazard model.ConclusionsVitamin D deficiency is highly prevalent in patients undergoing vascular access procedures. Patients who are deficient in vitamin D have worse survival and worse vascular access outcomes. Further study is warranted to assess whether aggressive vitamin D repletion will improve outcomes in this population.
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