Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients

Christiane Drechsler, Stefan Pilz, Barbara Obermayer-Pietsch, Marion Verduijn, Andreas Tomaschitz, Vera Krane, Katharina Espe, Friedo Dekker, Vincent Brandenburg, Winfried März, Eberhard Ritz, Christoph Wanner, Christiane Drechsler, Stefan Pilz, Barbara Obermayer-Pietsch, Marion Verduijn, Andreas Tomaschitz, Vera Krane, Katharina Espe, Friedo Dekker, Vincent Brandenburg, Winfried März, Eberhard Ritz, Christoph Wanner

Abstract

Aims: Dialysis patients experience an excess mortality, predominantly of sudden cardiac death (SCD). Accumulating evidence suggests a role of vitamin D for myocardial and overall health. This study investigated the impact of vitamin D status on cardiovascular outcomes and fatal infections in haemodialysis patients.

Methods and results: 25-hydroxyvitamin D [25(OH)D] was measured in 1108 diabetic haemodialysis patients who participated in the German Diabetes and Dialysis Study and were followed up for a median of 4 years. By Cox regression analyses, we determined hazard ratios (HR) for pre-specified, adjudicated endpoints according to baseline 25(OH)D levels: SCD (n = 146), myocardial infarction (MI, n = 174), stroke (n = 89), cardiovascular events (CVE, n = 414), death due to heart failure (n = 37), fatal infection (n = 111), and all-cause mortality (n = 545). Patients had a mean age of 66 ± 8 years (54% male) and median 25(OH)D of 39 nmol/L (interquartile range: 28-55). Patients with severe vitamin D deficiency [25(OH)D of ≤ 25 nmol/L] had a 3-fold higher risk of SCD compared with those with sufficient 25(OH)D levels >75 nmol/L [HR: 2.99, 95% confidence interval (CI): 1.39-6.40]. Furthermore, CVE and all-cause mortality were strongly increased (HR: 1.78, 95% CI: 1.18-2.69, and HR: 1.74, 95% CI: 1.22-2.47, respectively), all persisting in multivariate models. There were borderline non-significant associations with stroke and fatal infection while MI and deaths due to heart failure were not meaningfully affected.

Conclusion: Severe vitamin D deficiency was strongly associated with SCD, CVE, and mortality, and there were borderline associations with stroke and fatal infection. Whether vitamin D supplementation decreases adverse outcomes requires further evaluation.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for the time to (A) sudden cardiac death, (B) stroke, (C) combined cardiovascular events in subgroups of patients according to 25-hydroxyvitamin D levels at baseline [severely vitamin D deficient (≤25 nmol/L), moderately vitamin D deficient (>25 and ≤50 nmol/L), vitamin D insufficient (>50 and ≤75 nmol/L), and vitamin D sufficient (>75 nmol/L)].

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