Vitamin D levels and early mortality among incident hemodialysis patients
Vitamin D levels and early mortality among incident hemodialysis patients
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DOI：
10.1038/sj.ki.5002451
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发表时间：
2007-10-01
影响因子：
19.6
通讯作者：
Thadhani, R.
中科院分区：
文献类型：
--
作者：
Wolf, M.;Shah, A.;Thadhani, R.
维生素D缺乏与心血管疾病有关，心血管疾病是血液透析患者死亡的最常见原因。为了研究血液中25-羟基维生素D(25D)和1，25-二羟基维生素D(1，25D)水平与血液透析结果的关系，我们对825名连续的美国血液透析患者进行了横断面分析，测量了基线维生素D水平。在这些患者中，78%被认为缺乏维生素D，18%被认为严重缺乏。钙、磷和甲状旁腺激素水平与25D和1，25D浓度相关性较差。为了测试基线维生素D水平与90天死亡率之间的关联，我们选择了接下来的175名在90天内死亡的连续参与者，并将他们与嵌套病例对照分析中存活的750名患者进行了比较。虽然低维生素D水平与死亡率增加有关，但在维生素D水平、随后的积极维生素D治疗和存活率之间存在显著的交互作用。与接受治疗的25D或1，25D水平最高的患者相比，未经治疗的缺陷患者早期死亡的风险显著增加。我们的研究表明，在偶发的血液透析患者中，维生素D缺乏是常见的，与矿物质代谢的其他成分相关性较差，并与早期死亡率增加有关。
Vitamin D deficiency is associated with cardiovascular disease, the most common cause of mortality in hemodialysis patients. To investigate the relation between blood levels of 25-hydroxyvitamin D ( 25D) and 1,25-dihydroxyvitamin D ( 1,25D) with hemodialysis outcomes, we measured baseline vitamin D levels in a cross-sectional analysis of 825 consecutive patients from within a prospective cohort of incident US hemodialysis patients. Of these patients, 78% were considered vitamin D deficient with 18% considered severely deficient. Calcium, phosphorus, and parathyroid hormone levels correlated poorly with 25D and 1,25D concentrations. To test the association between baseline vitamin D levels and 90-day mortality, we selected the next 175 consecutive participants who died within 90 days and compared them to the 750 patients who survived in a nested case-control analysis. While low vitamin D levels were associated with increased mortality, significant interaction was noted between vitamin D levels, subsequent active vitamin D therapy, and survival. Compared to patients with the highest 25D or 1,25D levels who received therapy, untreated deficient patients were at significantly increased risk for early mortality. Our study shows that among incident hemodialysis patients, vitamin D deficiency is common, correlates poorly with other components of mineral metabolism and is associated with increased early mortality.