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Titolo Vitamin D Deficiency in Dialysis Patients: Effect of Dialysis Modality and Implications on Outcome
Autore Carolina Gracia-Iguacel,MD,* Paloma Gallar,MD, PhD,* Abdul R. Qureshi,MD, PhD,† Olimpia Ortega, PhD,* Carmen Mon, PhD,* Milagros Ortiz, MD, PhD,* Isabel Villarreal, PhD,* Concepcion Garcia-Lacalle, PhD,* Aniana Olieta, MD, PhD,* Maria Sa´nchez,* Juan C. Herrero, MD, PhD,* Ana Vigil, MD, PhD,* Beng Lindholm, MD, PhD,† and Juan J. Carrero, PhD†±§
Referenza Journal of Renal Nutrition 2010; doi:10.1053/j.jrn.2010.03.005
Contenuto Objective: Vitamin D deficiency has been linked to cardiovascular disease and mortality in hemodialysis (HD) patients. The purpose of the present cross-sectional study was to analyze the Vitamin D status of dialysis patients from a single center, study determinants of Vitamin D deficiency, and assess its implications on outcome. Methods: A prospective observational study of 115 prevalent dialysis patients was carried out, in which clinical and dialysis-related characteristics including routine biochemistry were studied in relation to levels of 25-hydroxyvitamin-D (25[OH]D, chemiluminescence). Survival was assessed after a median follow-up period of 413 days. Results: 25(OH)D deficiency and insufficiency was present in 51% and 42% of the patients, respectively. Only 7% of the patients showed normal 25(OH)D levels. Peritoneal dialysis patients presented the lowest 25(OH)D levels. Also, a significant difference was found between on-line hemodiafiltration (OL-HDF) and conventional HD (11 [6 to 16] versus 19 [13 to 27] ng/mL; P , 0.001; 25th to 75th percentiles, conventional HD versus OL-HDF respectively). In multinomial logistic regression analysis, patients on conventional HD had 8.35 greater odds (95% CI [2.04 to 34.20]) of 25(OH)D deficiency than OL-HDF even after adjustment for sex, parathyroid hormone, pH, and Charlson comorbidity index. During the follow-up period, 18 patients died. Both crude and adjusted (hazard ratio, 6.96; 95% CI [1.44 to 33.64]) Cox analysis identified 25(OH)D deficiency as a mortality risk factor. Conclusion: This observational study underlines the high prevalence of hypovitaminosis D in dialysis patients and its strong implications on outcome. Furthermore, our results suggest that OL-HDF was associated with a better preservation of the vitamin D status as compared with conventional HD.
Data 26.07.2010
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