European Journal of Nutrition

, Volume 56, Issue 3, pp 1017–1024 | Cite as

Independent associations of vitamin D metabolites with anemia in patients referred to coronary angiography: the LURIC study

  • J. B. Ernst
  • A. ZittermannEmail author
  • S. Pilz
  • M. E. Kleber
  • H. Scharnagl
  • V. M. Brandenburg
  • W. König
  • T. B. Grammer
  • W. März
Original Contribution



Anemia and vitamin D deficiency are both frequent in adult patients. Whether low vitamin D metabolite levels are an independent risk factor for different subtypes of anemia remains to be studied in detail.


In 3299 patients referred for coronary angiography, we investigated the association of 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D [1,25(OH)2D] with anemia [hemoglobin (Hb) <12.5 g/dl] of specific subtypes.


Compared with patients with 25OHD levels in the adequate range (50–125 nmol/l), patients with deficient 25OHD concentrations (<30 nmol/l; 33.6 % of patients) had 0.6 g/dl lower Hb levels. Hb values were 1.3 g/dl lower in patients with 1,25(OH)2D levels <40 pmol/l (5.4 % of patients), compared with patients in the highest 1,25(OH)2D category (>70 pmol/l). Of the participants, 16.7 % met the criteria for anemia. In multivariate-adjusted regression analyses, the odds ratios for anemia in the lowest 25OHD and 1,25(OH)2D categories were 1.52 (95 % CI 1.15–2.02) and 3.59 (95 % CI 2.33–5.52), compared with patients with 25OHD levels in the adequate range and patients with 1,25(OH)2D levels >70 pmol/l. The probability of anemia was highest in patients with combined 25OHD and 1,25(OH)2D deficiency [multivariable-adjusted odds ratio 5.11 (95 % CI 2.66–9.81)]. Patients with anemia of chronic kidney disease had the highest prevalence of 25OHD deficiency and 1,25(OH)2D concentrations of <40 pmol/l.


Low 25OHD and 1,25(OH)2D concentrations are independently associated with anemia. Patients with poor kidney function are most affected. Interventional trials are warranted to prove whether administration of plain or activated vitamin D can prevent anemia.


25-Hydroxyvitamin D 1,25-Dihydroxyvitamin D Anemia subtypes Hemoglobin Coronary angiography 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The LURIC study has been approved by the appropriate ethics committee (ethics committee at the ‘Ärztekammer Rheinland-Pfalz’ [Mainz, Germany]) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all individual participants included in the study.

Supplementary material

394_2015_1149_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • J. B. Ernst
    • 1
  • A. Zittermann
    • 1
    Email author
  • S. Pilz
    • 2
    • 3
  • M. E. Kleber
    • 4
  • H. Scharnagl
    • 5
  • V. M. Brandenburg
    • 6
  • W. König
    • 7
  • T. B. Grammer
    • 4
    • 8
  • W. März
    • 4
    • 5
    • 9
  1. 1.Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-WestphaliaRuhr University BochumBad OeynhausenGermany
  2. 2.Department of Internal Medicine, Division of Endocrinology and MetabolismMedical University of GrazGrazAustria
  3. 3.Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
  4. 4.Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) Mannheim Medical FacultyUniversity of HeidelbergMannheimGermany
  5. 5.Clinical Institute of Medical and Chemical Laboratory DiagnosticsMedical University of GrazGrazAustria
  6. 6.Department of CardiologyUniversity Hospital of the RWTH AachenAachenGermany
  7. 7.Department of Internal Medicine II – CardiologyUniversity of UlmUlmGermany
  8. 8.Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical FacultyUniversity of HeidelbergMannheimGermany
  9. 9.Synlab AcademySynlab Laboratory Services GmbHMannheimGermany

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