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What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

World Journal of Nephrology 2016年第5期5卷 471-481页

作者： Pablo Molina joséL Górriz Mariola D Molina Sandra Beltrán Belén Vizcaíno Verónica Escudero Julia Kanter Ana Iávila Jordi Bover Elvira Fernández Javier nieto Secundino Cigarrán Enrique Gruss Gema Fernández-Juárez Alberto Martínez-Castelao Juan F Navarro-González Ramón Romero luis M Pallardó Department of Nephrology Dr Peset University Hospital46017 ValenciaSpain Department of Medicine Universitat de València46005 ValenciaSpain Department of Mathematics Universidad de AlicanteSan Vicente del Raspeig03690 AlicanteSpain Department of Nephrology FundacióPuigvert080348 BarcelonaSpain Department of Nephrology Hospital Uni-versitari de LleidaIRBlleida(Institut de Reserca Biomèdica de Lleida)25198 LleidaSpain Department of Nephrology Hospital General Universitario de Ciudad Real13005 Ciudad RealSpain Department of Nephrology Hospital da Costa Burela7880 LugoSpain Department of Nephrology Hospital Universitario Fundación Alcorcón28922 MadridSpain Department of Nephrology Hospital Universitario de BeellvitgeIDIBELLL'Hospitalet de Llobregat08907 BarcelonaSpain Research Unit and Department of Nephrology University Hospital Nuestra Senora de Candelaria38010 Santa Cruz de TenerifeSpain Department of Medicine Universitat Autònoma de Barcelona08193 BarcelonaSpain

AIM To evaluate thresholds for serum 25(OH)D concentrations in relation to death, kidney progression and hospitalization in non-dialysis chronic kidney disease(CKD) *** Four hundred and seventy non-dialysis 3-5 stage CKD patients participating in OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into 3 groups according to 25(OH)D levels at enrollment(less than 20 ng/mL, between 20 and 29 ng/mL, and at or above 30 ng/mL), considering 25(OH)D between 20 and 29 ng/mL as reference group. Association between 25(OH)D levels and death(primary outcome), and time to first hospitalization and renal progression(secondary outcomes) over a 3-year followup, were assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. To identify 25(OH)D levels at highest risk for outcomes, receiver operating characteristic(ROC) curves were *** Over 29 ± 12 mo of follow-up, 46(10%) patients dead, 156(33%) showed kidney progression, and 126(27%) were hospitalized. After multivariate adjustment, 25(OH)D < 20 ng/mL was an independent predictor of all-cause mortality(HR = 2.33; 95%CI: 1.10-4.91; P = 0.027) and kidney progression(HR = 2.46; 95%CI: 1.63-3.71; P < 0.001), whereas the group with 25(OH)D at or above 30 ng/mL did not have a different hazard for outcomes from the reference group. Hospitalization outcomes were predicted by 25(OH) levels(HR = 0.98; 95%CI: 0.96-1.00; P = 0.027) in the unadjusted Cox proportional hazards model, but not after multivariate adjusting. ROC curves identified 25(OH)D levels at highest risk for death, kidney progression, and hospitalization, at 17.4 ng/mL [area under the curve(AUC) = 0.60; 95%CI: 0.685-0.69; P = 0.027], 18.6 ng/mL(AUC = 0.65; 95%CI: 0.60-0.71; P < 0.001), and 19.0 ng/m L(AUC = 0.56; 95%CI: 0.50-0.62; P = 0.048), ***25(OH)D < 20 ng/mL was an independent predictor of death and progression in patients with stage 3-5 CKD, with no addit

关键词： Vitamin D Chronic kidney disease Mortality Renal progression Hospitalization

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