Association of serum 25-hydroxyvitamin D with cardiovascular mortality and kidney outcome in patients with early stages of CKD

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发表日期：

2024年5月11日

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Y. Lin,
C. Xie,
Y. Zhang,
F. Luo,
Q. Gao,
Y. Li,
L. Su,
R. Xu,
X. Zhang,
R. Chen,
S. Zhou,
P. Li,
J. Liu,
M. Liang,
S. Nie,
Hong Xu,
Bicheng Liu,
Jianping Weng,
Chunbo Chen,
Huafeng Liu,
Qiongqiong Yang,
Yaozhong Kong,
Guisen Li,
Qijun Wan,
Yan Zha,
Ying Hu,
Gang Xu,
Yongjun Shi,
Yilun Zhou,
Guobin Su,
Ying Tang,
Mengchun Gong

摘要

Purpose

While serum 25-hydroxyvitamin D (25[OH]D) deficiency is prevalent in chronic kidney disease (CKD), the effects of 25(OH)D deficiency on cardiovascular mortality and kidney outcomes in patients with early-stage CKD remain incompletely understood.

Methods

This multicenter retrospective cohort study included adult patients with stages 1–3 CKD from 19 medical centers across China between January 2000 and May 2021. The primary outcome was cardiovascular mortality. The secondary study outcome included CKD progression (defined as a sustained > 40% eGFR decrease from baseline or progress to end-stage kidney disease), and annual percentage change of eGFR.

Results

Of 9229 adults with stages 1–3 CKD, 27.0% and 38.9% had severe (< 10 ng/mL) and moderate (10 to < 20 ng/mL) serum 25(OH)D deficiency, respectively. Compared with patients having 25(OH)D ≥ 20 ng/mL, a significantly higher risk of cardiovascular mortality (hazard ratio [HR] 1.90, 95% CI 1.37–2.63), CKD progression (HR 2.20, 95% CI 1.68–2.88), and a steeper annual decline in eGFR (estimate − 7.87%; 95% CI − 10.24% to − 5.51% per year) was found in those with serum 25(OH)D < 10 ng/mL. Similar results were obtained in subgroups and by sensitivity analyses.

Conclusions

25(OH)D deficiency is associated with increased risks of cardiovascular mortality and CKD progression in patients with early-stage CKD. Studies are needed to determine whether early intervention for 25(OH)D deficiency could improve the prognosis of patients with early-stage CKD.