NDT Advance Access originally published online on September 4, 2008
Nephrology Dialysis Transplantation 2009 24(2):611-618; doi:10.1093/ndt/gfn502
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25-Hydroxyvitamin D3, arterial calcifications and cardiovascular risk markers in haemodialysis patients
1 Hemodial—Dialysis Unit, Vila Franca de Xira 2 Dialverca-Dialysis Unit, Forte da Casa 3 NIDAN 4 Laboratório Dr Fernando Teixeira 5 Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
Correspondence and offprint requests to: Patrícia João Matias, Hemodial–Dialysis Unit, Quinta da Mina, lote 3 r/c, 2600-063 Vila Franca de Xira, Portugal. Tel: +35-191-998-2148; Fax: +35-126-327-6674; E-mail: patriciajoaomatias{at}hotmail.com
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Abstract |
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Background. Decreased vitamin D serum levels have been recently related to arterial stiffening and vascular calcifications in haemodialysis (HD) patients, but the pathophysiology of this association is not yet clear. The aim of this study was to evaluate the relationship between vascular calcifications, cardiovascular risk factors [including brain natriuretic peptide (BNP), pulse pressure (PP) and left ventricular mass index] and 25-hydroxyvitamin D3 (25(OH)D3) and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] serum levels.
Methods. We performed a cross-sectional study with 223 prevalent HD patients, 48% females, 27% diabetics, with the mean age of 62.7 ± 15.3 years and the mean HD time of 42.9 ± 39.3 months. Forty-seven percent of the patients were taking active forms of vitamin D.
Results. Serum levels of [25(OH)D3] were low (21.6 ± 12.2 ng/mL) and negatively correlated with age (r = –0.31, P < 0.001), diabetes mellitus (DM) (r = –0.20, P = 0.004), C-reactive protein (r = –0.25, P < 0.001), log10 BNP (r = –0.22, P = 0.002), PP > 65 mmHg (r = –0.21, P = 0.003) and vascular calcifications (r = –0.26, P < 0.001). Levels of [25(OH)D3] were positively correlated with [1,25(OH)2D3] (r = 0.25, P < 0.001) and albumin (r = 0.23, P = 0.001). On multivariate analysis, levels of [25(OH)D3] were independently associated with DM (P < 0.001), lower albumin levels (P = 0.003), higher BNP values (P = 0.005), PP > 65 mmHg (P = 0.006) and a higher vascular calcification score (
3) (P = 0.002).
Conclusions. These results suggest that lower levels of [25(OH)D3] are a cardiovascular risk marker in HD patients, since they are strongly associated with higher BNP levels, increased PP and with the presence of vascular calcifications. The exact role of [25(OH)D3] deficiency on cardiovascular morbi-mortality needs to be clarified in large randomized controlled trials.
Keywords: haemodialysis; mortality; vascular calcifications; vitamin D
Received for publication: 17. 4.08
Accepted in revised form: 13. 8.08
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