Serum 25-hydroxyvitamin D as a predictor of hospitalization-free survival in predialysis and dialysis patients with chronic kidney disease: A single-center prospective observational analysis

Abstract Background Vitamin D has pleiotropic effects important for the proper functioning of multiple organ systems. We investigated whether serum 25-hydroxyvitamin D (25(OH)D) levels influenced hospitalization-free survival in patients with chronic kidney disease. Methods In this prospective study, serum levels of 25(OH)D were measured in 210 patients with chronic kidney disease in the winter of 2009. Data regarding hospitalizations were collected over the subsequent 3 years. Results Vitamin D deficiency, as defined by a serum 25(OH)D level below 15 ng/ml, was observed in 76.7% of the patients. Mean 25(OH)D serum level was 13.6 ± 7.8 ng/ml in predialysis patients (n=62) and 11.3 ± 6.7 ng/ml in dialysis patients (n=148). During the follow–up, 107 patients (28 predialysis and 79 dialysis) were hospitalized due to infectious (33.6%) or cardiovascular diseases (23.4%). Predialysis and dialysis groups were divided into two subgroups based on median 25(OH)D serum level. Kaplan-Meier analysis revealed that the risk of hospitalization was significantly lower in both predialysis and dialysis patients with above median serum 25(OH)D levels (log rank test; P = 0.043 and 0.002, respectively). Multivariate Cox proportional hazards models also demonstrated that the risk of hospitalization was significantly lower for patients with higher serum 25(OH)D levels in both the predialysis (hazard ratio [HR] 0.963 , 95% confidence interval [CI] 0.93 - 0.99) and dialysis groups (HR 0.955 , 95% CI 0.91 - 0.99). Conclusions Lower serum 25(OH)D level predicted poorer hospitalization-free survival in both predialysis and dialysis chronic kidney disease patients.