Background: Vitamin D deficiency and protein-energy wasting (PEW) are highly prevalent in hemodialysis (HD) patients. The goal of our study was to investigate if a lack of vitamin D influences mortality and hospitalization of HD patients with or without PEW. Methods: In 81 chronic HD patients with different nutritional status assessed by the Malnutrition Inflammation Score (MIS), vitamin D deficiency (25-OH-vitamin D3 levels ≤30 nmol/l or ≤12 ng/ml) was prospectively investigated for its prognostic impact on mortality and hospitalization. Over a 3-year follow-up, all-cause mortality and hospitalization were determined. The predictive value of low vitamin D levels and PEW as well as their combined effect were evaluated using a multivariate Cox regression model. Results: Vitamin D deficiency was frequent in HD patients with and without PEW. It significantly increased mortality rate in HD patients (HR 2.76 (1.33–5.73), p < 0.01), which was aggravated by concomitant PEW (HR 5.88 (2.29–15.09), p < 0.001). The hospitalization rate, however, was not influenced independently by nutritional status. Conclusions: Low 25-OH-vitamin D3 concentration is an independent predictor for survival, but not for hospitalization of HD patients. It is not merely a malnutrition-associated finding, although a MIS ≧8 further impaired survival prognosis.

Holick MF, Schnoes HK, DeLuca HF, Suda T, Cousins RJ: Isolation and identification of 1,25-dihydroxycholecalciferol. A metabolite of vitamin D active in intestine. Biochemistry 1971;10:2799–2804.
Semmler EJ, Holick MF, Schnoes HK, DeLuca HF: The synthesis of 1α,25-dihydroxycholecalciferol – a metabolically active form of vitamin D3. Tetrahedron Lett 1972;40:4147–4150.
DeLuca HF: Overview of general physiological features and functions of vitamin D. Am J Clin Nutr 2004;80(suppl):1689S–1696S.
DeLuca HF, Engstrom GW, Rasmussen H: The action of vitamin D and parathyroid hormone in vitro on calcium uptake and release by kidney mitochondria. Biochemistry 1962;48:1604–1609.
Holick MF: Vitamin D deficiency. N Engl J Med 2007;357:266–281.
Dusso AS, Brown AJ, Slatopolsky E: Vitamin D. Am J Physiol Renal Physiol 2005;289:8–28.
Dobnig H, Pilz S, Scharnagl H, et al: Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008;168:1340–1349.
Melamed ML, Michos ED, Post W, Astor B: 25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 2008;168:1629–1637.
Kuroda T, Shiraki M, Tanaka S, Ohta H: Contributions of 25-hydroxyvitamin D, co-morbidities and bone mass to mortality in Japanese postmenopausal women. Bone 2009;44:168–172.
Matias PJ, Ferreira C, Jorge C, et al: 25-Hydroxyvitamin D3, arterial calcifications and cardiovascular risk markers in haemodialysis patients. Nephrol Dial Transplant 2009;24:611–618.
Melamed ML, Muntner P, Michos ED, et al: Serum 25-hydroxyvitamin D levels and prevalence of peripheral arterial disease. Arterioscler Thromb Vasc Biol 2008;28:1179–1185.
Michos ED, Melamed ML: Vitamin D and cardiovascular disease risk. Curr Opin Clin Nutr Metab Care 2008;11:7–12.
Ravani P, Malberti F, Tripepi G, et al: Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int 2009;75:88–95.
Wolf M, Shah A, Gutierrez O, et al: Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int 2007;72:1004–1013.
Fiedler R, Jehle PM, Dorligschaw O, Osten B, Girndt M: Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance. Nephrol Dial Transplant 2009;24:3812–3817.
Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH: A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 2001;38:1251–1263.
Pupim LB, Caglar K, Hakim RM, Shyr Y, Ikizler TA: Uremic malnutrition is a predictor of death independent of inflammatory status. Kidney Int 2004;66:2054–2060.
Stenvinkel P, Heimbürger O, Paultre F, et al: Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999;55:1899–1911.
Kaysen GA: The microinflammatory state in uremia: causes and potential consequences. J Am Soc Nephrol 2001;12:1549–1557.
Riella MC: Malnutrition in dialysis: malnourishment or uremic inflammatory response. Kidney Int 2000;57:1211–1232.
Bhan I, Burnett-Bowie SA, Ye J, Tonelli M, Thadhani R: Clinical measures identify vitamin D deficiency in dialysis. Clin J Am Soc Nephrol 2010;5:460–467.
Maetani M, Maskarinec, Franke AA, Cooney RV: Association of leptin, 25-hydroxyvitamin D, and parathyroid hormone in women. Nutr Cancer 2009;61:225–231.
Young KA, Engelman CD, Langefeld CD, et al: Association of plasma vitamin D levels with adiposity in Hispanic and African-Americans. J Clin Endocrinol Metab 2009;94:3306–3313.
Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G: Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant 2004;19:1507–1519.
Girndt M, Kaul H, Sester U, et al: Anti-inflammatory interleukin-10 genotype protects dialysis patients from cardiovascular events. Kidney Int 2002;62:949–955.
Pilz S, Dobnig H, Fischer JE, et al: Low vitamin D levels predict stroke in patients referred to coronary angiography. Stroke 2008;39:2611–2613.
Kovesdy CP, Kalantar-Zadeh K: Vitamin D receptor activation and survival in chronic kidney disease. Kidney Int 2008;73:1355–1363.
Teng M, Wolf M, Ofsthun MN, et al: Activated injectable vitamin D and hemodialysis survival. J Am Soc Nephrol 2005;16:1115–1125.
Andress DL: Vitamin D in chronic kidney disease: a systemic role for selective vitamin D receptor activation. Kidney Int 2006;69:33–43.
Dobrez DG, Mathes A, Amdahl M, Marx SE, Melnick JZ, Sprague SM: Paracalcitol-treated patients experience improved hospitalization outcomes compared with calcitriol patients in real world clinical settings. Nephrol Dial Transplant 2004;19:1174–1181.
Teng M, Wolf M, Lowrie E, Ofsthun M, Lazarus M, Thadhani R: Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med 2003;349:446–456.
Tentori F, Albert JM, Young EW, et al: Mortality risk among hemodialysis patients receiving different vitamin D analogs. Nephrol Dial Transplant 2009;24:963–972.
Anderson JL, May HT, Horne BD, et al: Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol 2010;106:963–968.
Kendrick J, Targher G, Smits G, Chonchol M: 25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey. Atherosclerosis 2009;205:255–260.
Jean G, Souberbielle JC, Chazot C: Monthly cholecalciferol administration in haemodialysis patients: a simple and efficient strategy for vitamin D supplementation. Nephrol Dial Transplant 2009;24:3799–3805.
Matias PJ, Jorge C, Ferreira C, et al: Cholecalciferol supplementation in hemodialysis patients: effects on mineral metabolism, inflammation, and cardiac dimension parameters. Clin J Am Soc Nephrol 2010;5:905–911.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.