Vitamin D deficiency is associated with mortality and adverse vascular access outcomes in patients with end-stage renal disease.

Abstract

BACKGROUND:

Plasma 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.

METHODS:

This 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.

RESULTS:

The 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.

CONCLUSIONS:

Vitamin 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.

• Authors: Joy P Walker, Jade S Hiramoto, Warren J Gasper, Philip Auyang, Michael S Conte, Joseph H Rapp, David H Lovett, Christopher D Owens
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 60 Issue 1 Pg. 176-83 (Jul 2014) ISSN: 1097-6809 [Electronic] United States
• PMID: 24582700 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Society for Vascular Surgery. All rights reserved.

Chemical References

• Serum Albumin
• Cholesterol
• Calcifediol
• Calcium

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Arteriovenous Shunt, Surgical (adverse effects)
• Blood Vessel Prosthesis (adverse effects)
• Calcifediol (blood, deficiency)
• Calcium (blood)
• Catheterization, Central Venous
• Cholesterol (blood)
• Coronary Disease (epidemiology)
• Follow-Up Studies
• Humans
• Hyperlipidemias (epidemiology)
• Kaplan-Meier Estimate
• Kidney Failure, Chronic (complications, mortality, therapy)
• Middle Aged
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Serum Albumin (metabolism)
• Vitamin D Deficiency (blood, complications, mortality)