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Association of serum 25-hydroxyvitamin D with cardiovascular mortality and kidney outcome in patients with early stages of CKD

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Abstract

Purpose

While serum 25-hydroxyvitamin D (25[OH]D) deficiency is prevalent in chronic kidney disease (CKD), the effects of 25(OH)D deficiency on cardiovascular mortality and kidney outcomes in patients with early-stage CKD remain incompletely understood.

Methods

This multicenter retrospective cohort study included adult patients with stages 1–3 CKD from 19 medical centers across China between January 2000 and May 2021. The primary outcome was cardiovascular mortality. The secondary study outcome included CKD progression (defined as a sustained > 40% eGFR decrease from baseline or progress to end-stage kidney disease), and annual percentage change of eGFR.

Results

Of 9229 adults with stages 1–3 CKD, 27.0% and 38.9% had severe (< 10 ng/mL) and moderate (10 to < 20 ng/mL) serum 25(OH)D deficiency, respectively. Compared with patients having 25(OH)D ≥ 20 ng/mL, a significantly higher risk of cardiovascular mortality (hazard ratio [HR] 1.90, 95% CI 1.37–2.63), CKD progression (HR 2.20, 95% CI 1.68–2.88), and a steeper annual decline in eGFR (estimate − 7.87%; 95% CI − 10.24% to − 5.51% per year) was found in those with serum 25(OH)D < 10 ng/mL. Similar results were obtained in subgroups and by sensitivity analyses.

Conclusions

25(OH)D deficiency is associated with increased risks of cardiovascular mortality and CKD progression in patients with early-stage CKD. Studies are needed to determine whether early intervention for 25(OH)D deficiency could improve the prognosis of patients with early-stage CKD.

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Data availability

The data used and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This study was made possible thanks to the CRDS study Investigators: Hong Xu, PhD, Children's Hospital of Fudan University, Shanghai, China; Bicheng Liu, MD, Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China.; Jianping Weng, Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.; Chunbo Chen, Department of Critical Care Medicine, Maoming People’s Hospital, Maoming, China; Huafeng Liu, Key Laboratory of Prevention and Management of Chronic Kidney Disease of Zhanjiang City, Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China; Qiongqiong Yang, Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Hua Li, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Yaozhong Kong, Department of Nephrology, the First People’s Hospital of Foshan, Foshan, Guangdong, China; Guisen Li, Renal Department and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Center for Kidney Diseases, Chengdu, China; Qijun Wan, The Second People’s Hospital of Shenzhen, Shenzhen University, Shenzhen, China; Yan Zha, Guizhou Provincial People’s Hospital, Guizhou University, Guiyang, China; Ying Hu, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; Gang Xu, Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Yongjun Shi, Huizhou Municipal Central Hospital, Sun Yat-Sen University, Huizhou, China; Yilun Zhou, Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Guobin Su, Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China; Ying Tang, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Mengchun Gong, Institute of Health Management, Southern Medical University, Guangzhou, China.

Funding

This study is supported by grants the National Key R&D Program of China (2021YFC2500200 and 2021YFC2500204), the National Natural Science Foundation of China (81900626).

Author information

Author notes

  1. Y. Lin, C. Xie and Y. Zhang have contributed equally.

Authors and Affiliations

  1. Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510515, China

    Y. Lin, Y. Zhang, F. Luo, Q. Gao, Y. Li, L. Su, R. Xu, X. Zhang, R. Chen, S. Zhou, P. Li, J. Liu, M. Liang & S. Nie

  2. Department of Nephrology, The First People’s Hospital of Foshan, Foshan, Guangdong, China

    C. Xie

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Consortia

for the CRDS study Investigators

  • Hong Xu
  • , Bicheng Liu
  • , Jianping Weng
  • , Chunbo Chen
  • , Huafeng Liu
  • , Qiongqiong Yang
  • , Yaozhong Kong
  • , Guisen Li
  • , Qijun Wan
  • , Yan Zha
  • , Ying Hu
  • , Gang Xu
  • , Yongjun Shi
  • , Yilun Zhou
  • , Guobin Su
  • , Ying Tang
  •  & Mengchun Gong

Contributions

SN, ML had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. YXL, CX, YPZ contributed equally as co-first authors. SN contributed to the study design. YXL, YPZ drafted the manuscript. YXL, FL contributed to the statistical analysis. QG, YQL, LCS, RQX, XDZ, RXC, SYZ, PPL, JL, the CRDS study Investigators, contributed to the data acquisition.

Corresponding authors

Correspondence to M. Liang or S. Nie.

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Ethical approval

The study protocol was approved by the China Office of Human Genetic Resources for Data Preservation Application (approval number: 2021-BC0037) and the Medical Ethics Committee of Nanfang Hospital, Southern Medical University (approval number: NFEC-2019–213).

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The study waived the requirement for patient informed consent because of the retrospective nature.

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Lin, Y., Xie, C., Zhang, Y. et al. Association of serum 25-hydroxyvitamin D with cardiovascular mortality and kidney outcome in patients with early stages of CKD. J Endocrinol Invest (2024). https://doi.org/10.1007/s40618-024-02383-6

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