@article{DrechslerPilzObermayerPietschetal.2010,
  author    = {Drechsler, Christiane and Pilz, Stefan and Obermayer-Pietsch, Barbara and Verduijn, Marion and Tomaschitz, Andreas and Krane, Vera and Espe, Katharina and Dekker, Friedo and Brandenburg, Vincent and Maerz, Winfried and Ritz, Eberhard and Wanner, Christoph},
  title     = {Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients},
  issn      = {0195-668X},
  doi       = {10.1093/eurheartj/ehq246},
  year      = {2010},
  abstract  = {Dialysis patients experience an excess mortality, predominantly of sudden cardiac death (SCD). Accumulating evidence suggests a role of vitamin D for myocardial and overall health. This study investigated the impact of vitamin D status on cardiovascular outcomes and fatal infections in haemodialysis patients. 25-hydroxyvitamin D [25(OH)D] was measured in 1108 diabetic haemodialysis patients who participated in the German Diabetes and Dialysis Study and were followed up for a median of 4 years. By Cox regression analyses, we determined hazard ratios (HR) for pre-specified, adjudicated endpoints according to baseline 25(OH)D levels: SCD (n = 146), myocardial infarction (MI, n = 174), stroke (n = 89), cardiovascular events (CVE, n = 414), death due to heart failure (n = 37), fatal infection (n = 111), and all- cause mortality (n = 545). Patients had a mean age of 66 +/- 8 years (54\% male) and median 25(OH)D of 39 nmol/L (interquartile range: 28-55). Patients with severe vitamin D deficiency [25(OH)D of < 25 nmol/L] had a 3-fold higher risk of SCD compared with those with sufficient 25(OH)D levels > 75 nmol/L [HR: 2.99, 95\% confidence interval (CI): 1.39- 6.40]. Furthermore, CVE and all-cause mortality were strongly increased (HR: 1.78, 95\% CI: 1.18-2.69, and HR: 1.74, 95\% CI: 1.22-2.47, respectively), all persisting in multivariate models. There were borderline non-significant associations with stroke and fatal infection while MI and deaths due to heart failure were not meaningfully affected. Severe vitamin D deficiency was strongly associated with SCD, CVE, and mortality, and there were borderline associations with stroke and fatal infection. Whether vitamin D supplementation decreases adverse outcomes requires further evaluation.},
  language  = {en}
}