Relationship between Vitamin D Deficiency, Albuminuria, Peripheral Artery Disease and 5-year Mortality in Chronic Kidney Disease.

Abstract

To investigate the effects of vitamin D deficiency, albuminuria and peripheral artery disease (PAD) relationships, on 5-year mortality in patients with chronic kidney disease (CKD) . Observational study. Department of Internal Medicine, Kartal Dr Lutfi Kırdar City Hospital, İstanbul, Turkey, from August 2015 to August 2020. The study included patients with stage 2-4 CKD, who were not previously diagnosed with peripheral artery disease (PAD) and were not on hemodialysis. Each patient's ankle-brachial index (ABI) was measured at rest with a portable vascular hand doppler; and an ABI of <0.9 was considered to be PAD. The mortality status of the participants were confirmed by the national death reporting system. A total of 110 CKD patients, mean age of 62.1±9.7 years, 36.4% women, were included in the study. It was found that 17.3% of the patients had vitamin D deficiency, 15.4% had vitamin D insufficiency, 32.7% had asymptomatic PAD, 33.9% had microalbuminuria and 39.4% had macroalbuminuria. It was observed that as vitamin D levels decreased, the frequency of albuminuria, and the prevalence of PAD, was on an increasing trend. A significant correlation was found between 5-year mortality, gender, body mass index (BMI), glomerular filtration rate (eGFR), urine albumin creatinine ratio (UACR), hemoglobin A1c (A1c), calcium (Ca), phosphate (P), vitamin D, ankle brachial index (ABI), and the neutrophil lymphocyte ratio (NLR) as a result of univariate cox-regressionanalysis. In the multivariate cox-regression model, it was observed that vitamin D, ABI and UACR levels continued being significant, independent of age, gender, BMI and eGFR levels. Conclusion: Vitamin D deficiency, PAD and albuminuria, which are separate predictors of mortality, were shown to be independent predictors of long-term mortality in CKD patients. Key Words: Chronic kidney disease, Mortality, Peripheral arterial disease, Vitamin D deficiency, Albuminuria, Ankle-brachial index.