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Vitamin D Affects Survival Independently of Vascular Calcification in Chronic Kidney Disease

Daniela Veit Barreto^*,, Fellype Carvalho Barreto^*,, Sophie Liabeuf^*,, Mohammed Temmar, Francis Boitte, Gabriel Choukroun^*,, Albert Fournier, and Ziad A. Massy^*,,

^* Institut National de la Santé et de la Recherche Medicale, Equipe Région INSERM 12 (Equipe d’Accueil 4292), Amiens, France; Clinical Research Centre, Division of Clinical Pharmacology, Amiens University Hospital, Amiens, France and the Jules Verne University of Picardy, Amiens, France; Division of Nephrology, Amiens University Hospital; Laboratory of Endocrine and Bone Biology, Amiens University Hospital

Correspondence: Dr. Professor Ziad A. Massy, INSERM ERI-12, Divisions of Clinical Pharmacology and Nephrology, Amiens University Hospital, Avenue René Laennec, F-80054 Amiens, France. Phone: + 33 322 455 788; Fax: + 33 322 455 660; E-mail: massy{at}u-picardie.fr

Background and objectives: Cardiovascular disease is the main cause of mortality in chronic kidney disease (CKD) patients. Vitamin D might have beneficial effects on vascular health. The aim of this study was to determine the prevalence of vitamin D deficiency (25-hydroxyvitamin D [25D] 15 ng/ml) and insufficiency (25D levels between 16 and 30 ng/ml) in a cohort of patients at different CKD stages and the relationships between vitamin D serum levels, vascular calcification and stiffness, and the mortality risk.

Design, setting, participants & measurements: One hundred forty CKD patients (85 men, mean age 67 ± 12 yr; CKD stages 2 [8%], 3 [26%], 4 [26%], 5 [7%], and 5D [(33%]) were allocated for a prospective study. Serum levels of 25D and 1,25-dihydroxyvitamin D, aortic calcification score, and pulse wave velocity (PWV) were evaluated.

Results: There was a high prevalence of vitamin D deficiency (42%) and insufficiency (34%). Patients with 25D 16.7 ng/ml (median) had a significantly lower survival rate than patients with 25D >16.7 ng/ml (mean follow-up, 605 ± 217 d; range, 10 to 889; P = 0.05). Multivariate adjustments (included age, gender, diabetes, arterial pressure, CKD stage, phosphate, albumin, hemoglobin, aortic calcification score and PWV) confirmed 25D level as an independent predictor of all-cause mortality.

Conclusions: Vitamin D deficiency and insufficiency were highly prevalent in this CKD cohort. Low 25D levels affected mortality independently of vascular calcification and stiffness, suggesting that 25D may influence survival in CKD patients via additional pathways that need to be further explored.

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				F. C. Barreto, D. V. Barreto, S. Liabeuf, N. Meert, G. Glorieux, M. Temmar, G. Choukroun, R. Vanholder, Z. A. Massy, and on behalf of the European Uremic Toxin Work Group Serum Indoxyl Sulfate Is Associated with Vascular Disease and Mortality in Chronic Kidney Disease Patients Clin. J. Am. Soc. Nephrol., October 1, 2009; 4(10): 1551 - 1558. [Abstract] [Full Text] [PDF]