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Serum 25-hydroxyvitamin D status and cardiovascular outcomes in chronic peritoneal dialysis patients: a 3-y prospective cohort study^1,2,3

¹ From the Departments of Medicine and Therapeutics (AY-MW, JES, MW, S-FL, MM-MS, and JW) and Chemical Pathology (CW-KL and IH-SC), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong

Background:Patients with kidney disease are at high risk of developing 25-hydroxyvitamin D [25(OH)D] deficiency.

Objective:We studied the association between serum 25(OH)D status and clinical outcomes of chronic peritoneal dialysis patients.

Design:We measured serum 25(OH)D concentrations in 230 prevalent peritoneal dialysis patients and then followed these patients prospectively for 3 y or until death.

Results:Serum 25(OH)D was deficient or insufficient (ie, <75nmol/L) in 87% of the patients. Adjusting for clinical and demographic factors, every 1-unit increase in log-transformed serum 25(OH)D was associated with a 44% reduction in the hazard of fatal or nonfatal cardiovascular events (95% CI: 0.35, 0.91; P = 0.018). However, the association was gradually lost when additional adjustment was made in a stepwise fashion for residual glomerular filtration rate (P = 0.078) and echocardiographic measures (P = 0.39). Kaplan-Meier estimates showed a significantly greater fatal or nonfatal cardiovascular event-free survival probability among patients with serum 25(OH)D > 45.7 nmol/L (median) than among patients with concentrations 45.7 nmol/L (P = 0.004). In addition, patients with 25(OH)D > 45.7 nmol/L had a significantly higher cardiovascular event-free survival probability than did patients with 25(OH)D 45.7 nmol/L in the stratified analysis for patients with left ventricular mass index less than the median (P = 0.013) or normal systolic function (P = 0.005).

Conclusions:A lower serum 25(OH)D concentration was associated with an increased risk of cardiovascular events in chronic peritoneal dialysis patients. Furthermore, serum 25(OH)D status appeared to show a differential influence on the cardiovascular outcomes of peritoneal dialysis patients depending on the degree of left ventricular hypertrophy and systolic dysfunction.

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