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Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD

Sankar D Navaneethan¹, Jesse D Schold, Susana Arrigain

¹Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland, OH 44195, USA. navanes@ccf.org

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation

|August 6, 2011

Abstract

Background:

Low 25-hydroxyvitamin D (25[OH]D) levels are common in patients with non-dialysis-dependent chronic kidney disease (CKD). The associations between low 25(OH)D levels and mortality in non-dialysis-dependent patients with CKD are unclear.

Study Design:

Retrospective cohort study.

Setting & Participants:

Patients with stages 3-4 CKD (estimated glomerular filtration rate, 15-59 mL/min/1.73 m(2); n = 12,673) who had 25(OH)D levels measured after the diagnosis of CKD in the Cleveland Clinic Health System.

Predictor:

25(OH)D levels categorized into 3 groups: <15, 15-29, and ≥30 ng/mL.

Outcomes:

We examined factors associated with low 25(OH)D levels and associations between low 25(OH)D levels and all-cause mortality (ascertained using the Social Security Death Index and our electronic medical record) using logistic regression, Cox proportional hazard models, and Kaplan-Meier survival curves.

Measurements:

25(OH)D was measured using chemiluminescence immunoassay.

Results:

Of 12,763 patients with CKD, 15% (n = 1,970) had 25(OH)D levels <15 ng/mL, whereas 45% (n = 5,749) had 25(OH)D levels of 15-29 ng/mL. Male sex, African American race, diabetes, coronary artery disease, and lower estimated glomerular filtration rate were associated significantly with 25(OH)D level <30 ng/mL. A graded increase in risk of 25(OH)D level <30 ng/mL was evident across increasing body mass index levels. Patients who had 25(OH)D levels measured in fall through spring had higher odds for 25(OH)D levels <30 ng/mL. After covariate adjustment, patients with CKD with 25(OH)D levels <15 ng/mL had a 33% increased risk of mortality (95% CI, 1.07-1.65). The group with 25(OH)D levels of 15-29 ng/mL did not show a significantly increased risk of mortality (HR, 1.03; 95% CI, 0.86-1.22) compared with patients with 25(OH)D levels ≥30 ng/mL.

Limitations:

Single-center observational study, lack of data for albuminuria and other markers of bone and mineral disorders, and attrition bias.

Conclusions:

25(OH)D level <15 ng/mL was associated independently with all-cause mortality in non-dialysis-dependent patients with CKD.

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