Mortality rates across 25-hydroxyvitamin D (25[OH]D) levels among adults with and without estimated glomerular filtration rate <60 ml/min/1.73 m2: the third national health and nutrition examination survey.

oleh: Holly Kramer, Chris Sempos, Guichan Cao, Amy Luke, David Shoham, Richard Cooper, Ramon Durazo-Arvizu

Format: Article
Diterbitkan: Public Library of Science (PLoS) 2012-01-01

Deskripsi

Previous studies exploring the association between 25[OH]D levels and mortality in adults with and without kidney disease utilized 25[OH]D thresholds that have recently been scrutinized by the Institute of Medicine Committee to Review Dietary References Intakes for Vitamin D and Calcium.We explored all-cause mortality rates across the spectrum of 25[OH]D levels over an eighteen-year follow-up among adults with and without an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2).The study included 1,097 U.S. adults with eGFR <60 ml/min/1.73 m(2) and 14, 002 adults with eGFR ≥60 ml/min/1.73 m(2). Mortality rates and rate ratios (RR) across 25[OH]D groups were calculated with Poisson regression and restricted cubic splines while adjusting for covariates.Prevalence of 25[OH]D levels <30 and <20 ng/ml among adults with eGFR <60 ml/min/1.73 m(2) was 76.5% (population estimate 6.2 million) and 35.4% (population estimate 2.9 million), respectively. Among adults with eGFR ≥ 60 ml/min/1.73 m(2), 70.5% had 25[OH]D levels <30 ng/ml (population estimate 132.2 million) while 30.3% had 25[OH]D levels <20 ng/ml (population estimate 56.8 million). Significantly higher mortality rates were noted among individuals with 25[OH]D levels <12 ng/ml compared to referent group (24 to <30 ng/ml): RR1.41 (95% CI 1.17, 1.71) among individuals with eGFR <60 ml/min/1.73 m(2) and RR 1.32 (95% CI 1.13, 1.56) among individuals with eGFR ≥ 60 ml/min/1.73 m(2) after adjustment for covariates including co-morbid conditions. Mortality rates were fairly similar across all 25[OH]D groups with levels >20 ng/ml after adjustment for all covariates.Regardless of presence of eGFR <60 ml/min/1.73 m(2), mortality rates across groups with 25[OH]D levels 20-40 ng/ml are similar.