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Impact of vitamin A on clinical outcomes in haemodialysis patients

Espe, Katharina M. ; Raila, Jens ; Henze, Andrea ; Krane, Vera ; Schweigert, Florian J. ; Hocher, Berthold ; Wanner, Christoph ; Drechsler, Christiane

In: Nephrology Dialysis Transplantation, 2011, vol. 26, no. 12, p. 4054-4061

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    Titel
    • Impact of vitamin A on clinical outcomes in haemodialysis patients
    Autor
    • Espe, Katharina M.. Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
    • Raila, Jens. Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
    • Henze, Andrea. Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
    • Krane, Vera. Department of Internal Medicine 1, Division of Nephrology, University of Würzburg, Würzburg, Germany
    • Schweigert, Florian J.. Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
    • Hocher, Berthold. Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
    • Wanner, Christoph. Department of Internal Medicine 1, Division of Nephrology, University of Würzburg, Würzburg, Germany
    • Drechsler, Christiane. Department of Internal Medicine 1, Division of Nephrology, University of Würzburg, Würzburg, Germany
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Nephrology Dialysis Transplantation, 2011, vol. 26, no. 12, p. 4054-4061. Oxford University Press
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:294227
    Summary
    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