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Vitamin D status and mortality risk among patients on dialysis: a systematic review and meta-analysis of observational studies.

Authors
  • Zhang, Yuhui1
  • Darssan, Darsy2
  • Pascoe, Elaine M2
  • Johnson, David W2, 3, 4
  • Pi, Haichen5
  • Dong, Jie1
  • 1 Department of Medicine Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China. , (China)
  • 2 Australasian Kidney Trials Network, Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia. , (Australia)
  • 3 Department of Kidney Disease, Translational Research Institute, Brisbane, Australia. , (Australia)
  • 4 Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia. , (Australia)
  • 5 Department of Emergency Medicine, Peking University First Hospital, Beijing, China. , (China)
Type
Published Article
Journal
Nephrology Dialysis Transplantation
Publisher
Oxford University Press
Publication Date
Oct 01, 2018
Volume
33
Issue
10
Pages
1742–1751
Identifiers
DOI: 10.1093/ndt/gfy016
PMID: 29481620
Source
Medline
Language
English
License
Unknown

Abstract

Vitamin D deficiency is highly prevalent in patients on dialysis. Although vitamin D deficiency is closely associated with cardiovascular disease (CVD) and high mortality in the general population, the relationship between serum 25-hydroxyvitamin D [25(OH)D] and all-cause and cardiovascular mortality in dialysis patients is uncertain. We aim to explore the relationship between serum 25(OH)D levels and all-cause and cardiovascular mortality in dialysis patients. This is a systematic review and meta-analysis of clinical studies among patients receiving maintenance dialysis. We did a systematic literature search in PubMed and Embase to identify studies reporting the relationship between serum 25(OH)D levels and all-cause and cardiovascular mortality in patients on dialysis. The search was last updated on 10 February 2017. The study included 18 moderate to high-quality cohort studies with an overall sample of 14 154 patients on dialysis. The relative risk of all-cause mortality per 10 ng/mL increase in serum 25(OH)D level was 0.78 [95% confidence interval (CI) 0.71-0.86], although there was marked heterogeneity (I2=96%, P < 0.01) that was partly explained by differences in CVD prevalence, baseline parathyroid hormone level and dialysis duration among included studies. The relative risk of cardiovascular mortality per 10 ng/mL increase in serum 25(OH)D level was 0.71 (95% CI 0.63-0.79), with substantial heterogeneity (I2=74%, P=0.004) that was largely explained by differences in study type and serum 25(OH)D measurement method. In the present study, increased serum 25(OH)D level was significantly associated with lower all-cause mortality and lower cardiovascular mortality in dialysis patients.

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