Severe Vitamin D Deficiency Raises Death Risk in Hemodialysis Patients

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Hemodialysis (HD) patients with severe vitamin D deficiency are more than twice as likely to die from any cause compared with those who have sufficient levels of the vitamin, according to a German study.

The study, which retrospectively examined data from 6,518 HD patients, also showed that severe vitamin D deficiency—defined as a 25-hydroxyvitamin D blood (25(OH)D) level below12.5 ng/mL—was associated with a significantly increased risk of death from cardiac disease, infectious disease, and cancer.

“The findings of this evaluation highlight the need to ensure an optimal vitamin D status especially in patients with end-stage kidney disease on hemodialysis,” the authors concluded in Anticancer Research (2012;32:391-396).

The investigators, led by Rolfdieter Krause, MD, of the KfH Nephrological Center in Maobit, Berlin, also concluded that their findings support the notion that “cholecalciferol supplementation, according to current clinical guidelines, is an essential part of the treatment of patients undergoing hemodialysis.”

Of the 6,518 subjects, 41.2% were had severe 25(OH)D deficiency. Compared with patients who were 25(OH)D sufficient (levels of 30 or above), those with severe deficiency had a 2.67 times increased risk of death from any cause and a 57%, 48%, and 51% increased risk of death from cardiac disease, infectious disease, and cancer, respectively, after adjusting for potential confounding factors.

Dr. Krause and his colleagues observed that their study results are consistent with data from HD patients in the United States and data from the general population. In addition, they noted that their finding of an increased risk of death from infectious causes agrees with evidence that vitamin D is linked to antibacterial defense mechanisms via the toll-like receptor and cathelicidin.

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