Vitamin D in Patients with Chronic Kidney Disease: Nothing New under the Sun

Tonelli, Marcello

doi:10.7326/0003-4819-147-12-200712180-00009

Cited by 20 publications

(12 citation statements)

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“…45 However, relevant data from randomised controlled trials on outcomes such as cardiovascular events or mortality, for which observational studies strongly suggest favourable effects of vitamin D treatment in chronic kidney disease, are still missing. [45][46][47][48] Our results are limited by the relatively low number of fatal events with subsequent high CIs of our HRs (Table 2), thus warranting further studies with larger study cohorts to confirm and extend our findings. Despite adjustments for various potential confounders, we cannot rule out that low serum 25(OH)D levels are only a nonspecific marker for a high risk of mortality, which is confounded by other unconsidered or unmeasured factors.…”

Section: Discussionmentioning

confidence: 67%

“…This finding contrasts the current recommendations for vitamin D treatment of patients with chronic kidney disease 45 . However, relevant data from randomised controlled trials on outcomes such as cardiovascular events or mortality, for which observational studies strongly suggest favourable effects of vitamin D treatment in chronic kidney disease, are still missing 45–48 …”

Section: Discussionmentioning

confidence: 79%

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Vitamin D and mortality in older men and women

Pilz

Dobnig

Nijpels

et al. 2009

Clinical Endocrinology

168

105

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SummaryObjective Vitamin D deficiency is common among the elderly and may contribute to cardiovascular disease. The aim of our study was to elucidate whether low serum levels of 25-hydroxyvitamin D [25(OH)D] are associated with an increased risk of all-cause and cardiovascular mortality. Design and patients The Hoorn Study is a prospective population-based study among older men and women. Measurements Fasting serum 25(OH)D was determined in 614 study participants at the follow-up visit in 2000-2001, the baseline for the present analysis. To account for sex differences and seasonal variations of 25(OH)D levels we formed sex-specific quartiles, which were calculated from the 25(OH)D values of each season.Results After a mean follow-up period of 6AE2 years, 51 study participants died including 20 deaths due to cardiovascular causes. Unadjusted Cox proportional hazard ratios (HRs; with 95% confidence intervals) for all-cause and cardiovascular mortality in the first when compared with the upper three 25(OH)D quartiles were 2AE24 (1AE28-3AE92; P = 0AE005) and 4AE78 (1AE95-11AE69; P = 0AE001), respectively. After adjustment for age, sex, diabetes mellitus, smoking status, arterial hypertension, high-density lipoproteincholesterol, glomerular filtration rate and waist-to-hip ratio, the HRs remained significant for all-cause [1AE97 (1AE08-3AE58; P = 0AE027)] and for cardiovascular mortality [5AE38 (2AE02-14AE34; P = 0AE001)]. Conclusions Low 25(OH)D levels are associated with all-cause mortality and even more pronounced with cardiovascular mortality, but it remains unclear whether vitamin D deficiency is a cause or a consequence of a poor health status. Therefore, intervention studies are warranted to evaluate whether vitamin D supplementation reduces mortality and cardiovascular diseases.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 79%

Vitamin D and mortality in older men and women

Pilz

Dobnig

Nijpels

et al. 2009

Clinical Endocrinology

168

105

View full text Add to dashboard Cite

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“…A causal relationship has yet to be proved by intervention trials using vitamin D. Several mechanisms might explain the 25-hydroxyvitamin D deficiency in the CKD population. First, almost patients with CKD have restricted protein and caloric intake, so vitamin D is relatively low [22]. Second, many CKD patients have limited outdoor physical activities with reduced exposure to sunlight [22].…”

Section: Discussionmentioning

confidence: 99%

“…First, almost patients with CKD have restricted protein and caloric intake, so vitamin D is relatively low [22]. Second, many CKD patients have limited outdoor physical activities with reduced exposure to sunlight [22]. Finally, greater loss of urinary vitamin D metabolites occurs in patients with overt proteinuria [23].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D insufficiency and deficiency with stages of chronic kidney disease in an Asian population

et al. 2013

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BackgroundVitamin D insufficiency is associated with proteinuria and could be a risk factor for end-stage renal disease (ESRD). However, few studies have examined the significance of vitamin D insufficiency as a contributing factor for the development of ESRD in the Asian chronic kidney disease (CKD) population.MethodsAuthors examined the relationship between vitamin D status and the staging of CKD using data from an outpatient clinic-based screening in 2,895 Thai CKD patients. Serum levels of 25-hydroxyvitamin D were analyzed according to CKD stages. Vitamin D deficiency and insufficiency were defined as a serum 25-hydroxyvitamin D concentration < 10 ng/mL and 10–30 ng/mL, respectively.ResultsThe mean (SD) 25-hydroxyvitamin D levels were significantly lower according to severity of renal impairment (CKD stage 3a: 27.84±14.03 ng/mL, CKD stage 3b: 25.86±11.14 ng/mL, CKD stage 4: 24.09±11.65 and CKD stage 5: 20.82±9.86 ng/mL, p<0.001). The prevalence of vitamin D deficiency/insufficiency was from CKD stage 3a, 3b, 4 to 5, 66.6%, 70.9%, 74.6%, and 84.7% (p<0.001). The odds ratio (95% CI) of vitamin D insufficiency/deficiency (serum 25-hydroxyvitamin D ≤ 30 ng/mL) and vitamin D deficiency (serum 25-hydroxyvitamin D < 10 ng/mL) for developing ESRD, after adjustment for age, gender, hemoglobin, serum albumin, calcium, phosphate and alkaline phosphatase were 2.19 (95% CI 1.07 to 4.48) and 16.76 (95% CI 4.89 to 57.49), respectively.ConclusionThis study demonstrates that 25-hydroxyvitamin D insufficiency and deficiency are more common and associated with the level of kidney function in the Thai CKD population especially advanced stage of CKD.

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“…Although it has been postulated that the mechanism of immunomodulation as a result of secondary hyperparathyroidism is through PTH (14,29,30) or vitamin D (31) levels, we found no difference in our main results when we adjusted for PTH and vitamin D use. It should be noted that our study predates the widespread use of newer vitamin D agents (doxercalciferol and paricalcitol), according to opinion-based guidelines for vitamin D levels in dialysis patients; however, a recent meta-analysis showed that the association of vitamin D use with improved health outcomes in patients with kidney disease remains controversial (32,33).…”

Section: Discussionmentioning

confidence: 99%

Serum Phosphate Levels and Risk of Infection in Incident Dialysis Patients

Plantinga

Fink

Melamed

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: Hyperphosphatemia is highly prevalent in dialysis patients and may be associated with immune dysfunction. The association of serum phosphate level with infection remains largely unexamined.Design, setting, participants, & measurements: In an incident cohort of 1010 dialysis patients enrolled from 1995 to 1998 and treated in 80 US clinics, the association of phosphate level (low <3.5; normal 3.5 to 5.5; high >5.5 mg/dl) at baseline and during follow-up with the risk for incident inpatient and outpatient infection-related events was examined. Infectious events were identified from US Renal Data System data (mean follow-up 3.3 yr). Incidence rate ratios for all infections, sepsis, respiratory tract infections, and osteomyelitis were obtained using multivariable Poisson models, adjusting for potential confounders (age, race, gender, smoking, comorbidity, and laboratory values).Results: Infections of any type (n ‫؍‬ 1398) were more frequent among patients with high phosphate levels at baseline, relative to normal; this association was not changed by adjustment for parathyroid hormone level. Similarly, high versus normal baseline phosphate was associated with increased risk for sepsis and osteomyelitis but not respiratory tract infections. Associations with calcium were generally NS, and results with calcium-phosphate product mirrored the phosphate results.Conclusions: High phosphate levels may be associated with increased risk for infection, contributing further to the rationale for aggressive management of hyperphosphatemia in dialysis patients.

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Vitamin D in Patients with Chronic Kidney Disease: Nothing New under the Sun

Cited by 20 publications

References 11 publications

Vitamin D and mortality in older men and women

Vitamin D and mortality in older men and women

Vitamin D insufficiency and deficiency with stages of chronic kidney disease in an Asian population

Serum Phosphate Levels and Risk of Infection in Incident Dialysis Patients

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