Abstract
BackgroundLow circulating vitamin D levels have been suggested to potentially contribute to acute complications in critically ill patients. However, in patients with acute kidney injury (AKI), whether vitamin D deficiency occurs and is a potential contributor to worse early outcomes at the time of AKI diagnosis remains unclear.Methodology/Principal FindingsTwo hundred patients with AKI were enrolled in our study. Healthy subjects and critically ill patients without AKI served as controls. Serum vitamin D concentrations were measured in the three groups. The patients with AKI were followed up for 90 days and grouped according to median serum vitamin D concentrations. In addition, vitamin D receptor polymorphisms (BsmI and FokI) were measured in these patients; they were also followed up for 90 days and grouped according to vitamin D receptor gene mutations. Low serum 1,25-dihydroxyvitamin D levels (59.56±53.00 pmol/L) were detected in patients with AKI and decreased with increasing severity of AKI. There were no significant findings with respect to 25-hydroxyvitamin D. The 90-day survival curves of individuals with high vitamin D concentrations showed no significant differences compared with the curves of individuals with low concentrations. The survival curves of patients with BB/Bb or FF/Ff genotypes also showed no significant differences compared with patients with bb or ff genotypes. In Cox regression analysis, the vitamin D status in patients with AKI was not an independent prognostic factor as adjusted by age, sex, Sequential Organ Failure Assessment score, or vitamin D receptor polymorphisms.Conclusions/SignificancePatients with AKI manifested a marked decrease in the 1,25-dihydroxyvitamin D level at the time of AKI diagnosis, and the degree of 1,25-dihydroxyvitamin D deficiency increased with the severity of AKI. No association between the serum vitamin D level at the time of AKI diagnosis and 90-day all-cause mortality was found in patients with AKI.
Highlights
Vitamin D deficiency is very prevalent in the adult population worldwide [1,2,3] and has been demonstrated to strongly correlate with long-term overall mortality in the general population [4,5,6]
Our observational study showed that patients with acute kidney injury (AKI) manifested a marked decrease in the serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels at the time of AKI diagnosis and that the degree of 1,25-dihydroxyvitamin D deficiency increased as the severity of AKI increased
No association between either the 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D level at the time of AKI diagnosis and 90-day all-cause mortality was found in patients with AKI
Summary
Vitamin D deficiency is very prevalent in the adult population worldwide [1,2,3] and has been demonstrated to strongly correlate with long-term overall mortality in the general population [4,5,6]. Vitamin D has pleiotropic effects on immunity, endothelial and mucosal functions, and glucose and calcium metabolism [7] These effects may account for the association between its deficiency and the increased mortality and morbidity associated with a variety of chronic illnesses such as coronary disease, tuberculosis, malignant tumors, and chronic renal disease. Serious deficiency of 25-hydroxyvitamin D in critically ill patients and its association with increased mortality has been a focus of recent studies [8,9,10,11,12,13]. Braun et al [12,13] showed that vitamin D deficiency prior to hospital admission or at the time of critical care is independently associated with increased morbidity and mortality in patients with critical illness. In patients with acute kidney injury (AKI), whether vitamin D deficiency occurs and is a potential contributor to worse early outcomes at the time of AKI diagnosis remains unclear
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