Vitamin D deficiency, cardiothoracic ratio, and long-term mortality in hemodialysis patients

Heng-Jung Hsu,Chin-Chan Lee,Chun-Yu Chen,I-Wen Wu,Chiao-Yin Sun,Kuang-Hung Hsu

doi:10.1038/s41598-020-64359-9

Abstract

Hemodialysis patients are a special group of patients with higher mortality rates. Hemodialysis patients with vitamin D deficiency {plasma levels of 25-hydroxyvitamin D [25(OH)D] below 20 ng/mL} are associated with even higher mortality rates. The prognostic importance of vitamin D deficiency in hemodialysis patients with different cardiothoracic ratios (CTRs) is still unclear. This prospective study was performed in a single hemodialysis center, and 186 patients were included. This study analyzed the prognostic importance of vitamin D deficiency in hemodialysis patients with different CTRs. Vitamin D deficiency patients had a significantly higher prevalence of stroke and diabetic mellitus than those without vitamin D deficiency. In addition, the CTR was higher in patients with vitamin D deficiency than in those without vitamin D deficiency. After multivariate logistic regression, we found that CTR was the solitary factor that was independently significantly associated with vitamin D deficiency [odds ratio: 1.07, 95% confidence internal (CI): 1.01–1.13, p = 0.02]. Additionally, vitamin D deficiency was associated with all-cause mortality in patients with higher CTR after adjustment in hierarchical regression models. In conclusion, we reported that vitamin D deficiency was independently significantly associated with a higher CTR. We additionally revealed that vitamin D deficiency was an independent predicator for all-cause mortality in higher CTR hemodialysis patients.

Highlights

Hemodialysis patients are a special group of patients with higher mortality rates
The prevalence of vitamin D deficiency is even higher in chronic kidney disease (CKD) patients undergoing peritoneal dialysis, and the prevalence rates ranging from 86% to 100%7,8
Some experimental studies with vitamin D receptor knock-out mice found impaired immunity, type 2 diabetes mellitus (DM), and cardiovascular disease develop in those mice[20,21,22], which indicates that the possible cause of the poor prognosis associated with vitamin D deficiency may be related to cardiovascular disease, infections, or comorbidity of type 2 DM

Summary

Introduction

Hemodialysis patients with vitamin D deficiency {plasma levels of 25-hydroxyvitamin D [25(OH)D] below 20 ng/mL} are associated with even higher mortality rates. The prognostic importance of vitamin D deficiency in hemodialysis patients with different cardiothoracic ratios (CTRs) is still unclear. This prospective study was performed in a single hemodialysis center, and 186 patients were included. Vitamin D deficiency was associated with all-cause mortality in patients with higher CTR after adjustment in hierarchical regression models. We revealed that vitamin D deficiency was an independent predicator for all-cause mortality in higher CTR hemodialysis patients. In CKD patients undergoing hemodialysis, the prevalence of vitamin D deficiency is approximately 50–98%5–7. Cardiac disorders in pediatric CKD patients and vitamin D deficiency could provide information about the possible pathophysiology of vitamin D deficiency and mortality

Methods

Results

Conclusion