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- Title
Impact of vitamin A on clinical outcomes in haemodialysis patients.
- Authors
Espe, Katharina M.; Raila, Jens; Henze, Andrea; Krane, Vera; Schweigert, Florian J.; Hocher, Berthold; Wanner, Christoph; Drechsler, Christiane
- Abstract
Background. Patients on maintenance haemodialysis treatment experience an excessive risk of cardiovascular disease and mortality. The vitamin A concentration is known to be higher in these patients compared to the general population where elevated vitamin A concentrations are associated with adverse outcome. The impact of vitamin A on morbidity and mortality in end-stage renal disease patients is controversial and is the topic of this study.Methods. We analysed plasma retinol and retinol-binding protein 4 (RBP4) in 1177 diabetic haemodialysis patients, who participated in the German Diabetes and Dialysis Study (median follow-up 4 years). By Cox regression analyses hazard ratios (HRs) were determined for pre-specified, adjudicated end points according to baseline concentrations.Results. Patients had a mean age of 66 ± 8 years, mean retinol and RBP4 concentrations of 3.28 (0.71–7.44) and 4.02 (1.28–10.1) μmol/L, respectively. Patients with retinol concentrations in the first quartile (<2.6 μmol/L) had an almost 2-fold increased risk of all-cause mortality compared to patients of the fourth quartile [>3.9 μmol/L; HR 1.81, 95% confidence interval (CI) 1.43–2.30]. There was a strong association between low retinol and the risk of sudden cardiac death (SCD, HR 2.22, 95% CI 1.41–3.50) and fatal infection (HR 2.19, 95% CI 1.26–3.82). Patients with RBP4 concentrations in the lowest quartile (<3.0 μmol/L) were more likely to die of any cause (HR 1.43, 95% CI 1.14–1.80), experience SCD (HR 1.97, 95% CI 1.28–3.03) and cardiovascular events (HR 1.43, 95% CI 1.10–1.85).Conclusion. This large cohort study shows a strong association of low retinol and RBP4 concentrations with SCD and all-cause mortality in diabetic haemodialysis patients.
- Subjects
HEMODIALYSIS patients; CARDIOVASCULAR diseases risk factors; VITAMIN A; CARDIOVASCULAR disease related mortality; HEALTH outcome assessment; CHRONIC kidney failure; CARRIER proteins; PATIENTS
- Publication
Nephrology Dialysis Transplantation, 2011, Vol 26, Issue 12, p4054
- ISSN
0931-0509
- Publication type
Article