Kidney Week

Abstract: FR-PO779

Vitamin D and Risk of Infection in Long-Term Dialysis Patients: A Systematic Review and Meta-Analysis

Session Information

• Dialysis: Inflammation and Infection
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Su, Guobin, Karolinska Institutet, Stockholm, Sweden

Guobin Su,

• Liu, Zhuangzhu, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guanghzou, China

Zhuangzhu Liu,

• Qin, Xindong, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guanghzou, China

Xindong Qin,

• Xu, Hong, Karolinska Institutet, Stockholm, Sweden

Hong Xu,

• Liu, Xusheng, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guanghzou, China

Xusheng Liu,

• Wen, Zehuai, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guanghzou, China

Zehuai Wen,

• Lindholm, Bengt, Karolinska Institutet, Stockholm, Sweden

Bengt Lindholm,

• Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Sweden

Juan Jesus Carrero,

• Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia

David W. Johnson,

• Brusselaers, Nele, Karolinska Institutet, Stockholm, Sweden

Nele Brusselaers,

• Lundborg, Cecilia Stålsby, Karolinska Institutet, Stockholm, Sweden

Cecilia Stålsby Lundborg,

Background

Infections are common and can be fatal in patients undergoing long-term dialysis. Current studies have shown conflicting evidence associating infection with vitamin D, which have not been systematically reviewed in this population

Methods

We searched PubMed, Web of Science, Cochrane Library, Embase databases and three Chinese databases, from inception through December 2017, for interventional (non-randomized or randomized controlled trials, RCTs), cohort and case-controlled studies on levels of serum 25-hydroxy vitamin D (25(OH)D); or use of vitamin D [supplemental nutritional vitamin D or vitamin D receptor activator (VDRA)] and infection (any infection, infection-required hospitalization or infection-related death, or composite), in long-term dialysis patients. We conducted a meta-analysis on the relative risk of infection and level of 25(OH)D or use of vitamin D.

Results

Of 2,440 reports identified, 17 studies met inclusion criteria, all with moderate quality, with 6 cohort studies evaluating 25(OH)D serum concentrations (N=5,714) and 11 (2 RCTs and 9 observational studies) evaluating the use of vitamin D (N=92,309). The risk of composite infection was 39% lower (relative risk [RR] 0.61, 95% CI 0.41-0.89) in those with high/normal levels of 25(OH)D than in those with low levels. Compared to those who did not use vitamin D, the pooled adjusted risk for composite infection was 41% lower in those who used vitamin D (RR 0.59, 95% CI 0.43-0.81).

Conclusion

High/normal serum levels of 25(OH)-vitamin D and use of vitamin D, particularly VDRA, were each associated with a lower risk of composite infection in long-term dialysis patients.

Figure: Forest plot depicting the meta-association between use and non-use of Vitamin D, and high/normal vs. low level of 25(OH)D, and risk for infection-related outcomes

Funding

• Government Support - Non-U.S.