Vitamin D deficiency, mortality, and hospitalization in hemodialysis patients with or without protein-energy wasting.

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 D(3) 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 D(3) 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.