Low Vitamin D and High Fibroblast Growth Factor 23 Serum Levels Associate with Infectious and Cardiac Deaths in the HEMO Study
Chonchol M, Greene T, Zhang Y, Hoofnagle AN, Cheung AK
Journal of the American Society of Nephrology : JASN · 113 citas
Cómo se estudió
- Diseño
- Ensayo controlado aleatorizado (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- National Institute of Diabetes and Digestive and Kidney Diseases
- Gobierno
- NIDDK NIH HHS
- Subvenciones
- National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK 081473)
Según 2 financiadores declarados.
Publicación
- Publicado
- 2015-05-13 · J Am Soc Nephrol · vol. 27 · número 1 · págs. 227–237
- Editorial
- American Society of Nephrology
- Citado
- 144 citas · más que el 99% de estudios similares · 14.0× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 45 trabajos
- Acceso
- Acceso abierto (copia en repositorio)
- Áreas de investigación
- Parathyroid Disorders and Treatments · Vitamin D Research Studies · Dialysis and Renal Disease Management
- Palabras clave
- vitamin D, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, fibroblast growth factor 23, hemodialysis, infectious disease mortality, cardiac mortality, all-cause mortality, mineral metabolism disorders, inflammatory markers, HEMO study
- MeSH
- humans, bacterial infections, heart diseases, fibroblast growth factors, vitamin d, renal dialysis, prospective studies, middle aged, female, male, renal insufficiency, chronic, fibroblast growth factor-23
5 autores
- Michel Chonchol🇺🇸 · autor de correspondenciaUniversity of Colorado Denver
- Tom Greene🇺🇸University of Utah
- Yingying Zhang🇺🇸University of Utah
- Andrew N. Hoofnagle🇺🇸University of Washington
- Alfred K. Cheung🇺🇸University of Utah; VA Salt Lake City Healthcare System; University of Utah Health Care
Resumen
El texto original del estudio, en el idioma en que se publicó.
Longitudinal studies testing the relationship between repeated measures of vitamin D or fibroblast growth factor 23 (FGF23) and infectious and cardiac hospitalizations and death in hemodialysis patients have not been reported. We examined the association between yearly 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)2D), and FGF23 serum levels and various clinical outcomes using time-dependent Cox regression models with repeated yearly measures and fixed-covariate Cox models with only baseline values after controlling for important clinical covariates in the HEMO study. During a median follow-up of 3 years, 582 of the 1340 participants died, and 499 and 514 participants had a hospitalization or death attributed to infectious and cardiac causes, respectively. Patients in the highest 25(OH)D quartile had the lowest risk of infectious events (hazard ratio [HR] 0.66 versus the lowest quartile; 95% confidence interval [95% CI], 0.49-0.89), cardiac events (HR, 0.71; 95% CI, 0.53-0.96), and all-cause mortality (HR, 0.46; 95% CI, 0.34-0.62) in time-dependent analyses. No significant associations of 1,25(OH)2D with clinical outcomes were observed in time-dependent or fixed-covariate Cox models. In contrast, the highest FGF23 quartile was associated with a higher risk of infectious events (HR, 1.57 versus the lowest quartile; 95% CI, 1.13-2.18), cardiac events (HR, 1.49; 95% CI, 1.06-2.08), and all-cause mortality (HR, 1.50; 95% CI, 1.07-2.12) in fixed-covariate Cox models. The addition of inflammation markers into the statistical models did not attenuate these associations. Thus, disordered mineral metabolism may affect outcomes in chronic hemodialysis patients.
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