Vitamin D Supplementation Can Improve the 28-day Mortality Rate in Patients with Sepsis-associated Acute Kidney Injury

Overview

Journal Ren Fail

Publisher Informa Healthcare

Date 2024 Nov 25

PMID 39584485

Authors

Lei Chen

Tiantian Zhou

Chenwei Lv

Haibin Ni

Zhigang Zhao

Hanhui Zhou

Xingxing Hu

Affiliations

Soon will be listed here.

Abstract

Purpose: Vitamin D levels are generally lower in septic patients and are associated with poor prognosis. Observational studies suggest improved renal recovery in acute kidney injury (AKI) patients with increased vitamin D levels. Still, large RCTs did not show significant clinical benefits, possibly due to the limited number of sepsis or AKI patients included. This study aimed to examine the impact of vitamin D supplementation on 28-day all-cause mortality in patients with sepsis-associated acute kidney injury (S-AKI).

Methods: A retrospective cohort study was conducted using data from the MIMIC-IV (v2.0) database, which included 18,713 ICU patients with S-AKI. Propensity score matching (PSM) was used to adjust for confounding factors, and multivariate Cox regression was employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Patient survival and clinical characteristics will be assessed utilizing Kaplan-Meier curves, with comparisons conducted using the log-rank test.

Results: Kaplan-Meier survival analysis revealed significant differences in survival between the groups. Multivariate Cox regression indicated a reduced risk of 28-day mortality associated with vitamin D supplementation (HR: 0.73, 95% CI: 0.67-0.80, < 0.001). The results after PSM were consistent with those of the original cohort. Similar results were observed for in-hospital mortality and 90-day mortality. The Restricted Cubic Spline curve (RCS) indicated an increasing trend in the therapeutic effect of vitamin D with increasing SOFA score.

Conclusions: Vitamin D supplementation is associated with decreased all-cause mortality in patients with S-AKI, and those with more severe conditions may benefit even more.

References

Amrein K, Schnedl C, Holl A, Riedl R, Christopher K, Pachler C . Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA. 2014; 312(15):1520-30. DOI: 10.1001/jama.2014.13204. View

Chang Y, Chou Y, Kan W, Shiao C . Sepsis and Acute Kidney Injury: A Review Focusing on the Bidirectional Interplay. Int J Mol Sci. 2022; 23(16). PMC: 9408949. DOI: 10.3390/ijms23169159. View

Yang B, Zhu Y, Zheng X, Li T, Niu K, Wang Z . Vitamin D Supplementation during Intensive Care Unit Stay Is Associated with Improved Outcomes in Critically Ill Patients with Sepsis: A Cohort Study. Nutrients. 2023; 15(13). PMC: 10346786. DOI: 10.3390/nu15132924. View

Hwang H, Yang K, Park K, Choi H, Kim S, Hong S . Pretreatment with paricalcitol attenuates inflammation in ischemia-reperfusion injury via the up-regulation of cyclooxygenase-2 and prostaglandin E2. Nephrol Dial Transplant. 2012; 28(5):1156-66. DOI: 10.1093/ndt/gfs540. View

Cui A, Xiao P, Ma Y, Fan Z, Zhou F, Zheng J . Prevalence, trend, and predictor analyses of vitamin D deficiency in the US population, 2001-2018. Front Nutr. 2022; 9:965376. PMC: 9573946. DOI: 10.3389/fnut.2022.965376. View

Jeng L, Yamshchikov A, Judd S, Blumberg H, Martin G, Ziegler T . Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med. 2009; 7:28. PMC: 2684740. DOI: 10.1186/1479-5876-7-28. View

Park J, Hong I, Chung J, Choi H . Vitamin D status in South Korean population: Seven-year trend from the KNHANES. Medicine (Baltimore). 2018; 97(26):e11032. PMC: 6242298. DOI: 10.1097/MD.0000000000011032. View

Jiang S, Zhang H, Li X, Yi B, Huang L, Hu Z . Vitamin D/VDR attenuate cisplatin-induced AKI by down-regulating NLRP3/Caspase-1/GSDMD pyroptosis pathway. J Steroid Biochem Mol Biol. 2020; 206:105789. DOI: 10.1016/j.jsbmb.2020.105789. View

Guan J, Shichen M, Liang Z, Yu S, Zhao M, Zhang L . Potential benefits of vitamin D for sepsis prophylaxis in critical ill patients. Front Nutr. 2023; 10:1073894. PMC: 10110989. DOI: 10.3389/fnut.2023.1073894. View

10.

Peerapornratana S, Manrique-Caballero C, Gomez H, Kellum J . Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int. 2019; 96(5):1083-1099. PMC: 6920048. DOI: 10.1016/j.kint.2019.05.026. View

11.

Zarbock A, Nadim M, Pickkers P, Gomez H, Bell S, Joannidis M . Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol. 2023; 19(6):401-417. DOI: 10.1038/s41581-023-00683-3. View

12.

Kuwabara S, Goggins E, Okusa M . The Pathophysiology of Sepsis-Associated AKI. Clin J Am Soc Nephrol. 2022; 17(7):1050-1069. PMC: 9269625. DOI: 10.2215/CJN.00850122. View

13.

Johnson A, Pollard T, Shen L, Lehman L, Feng M, Ghassemi M . MIMIC-III, a freely accessible critical care database. Sci Data. 2016; 3:160035. PMC: 4878278. DOI: 10.1038/sdata.2016.35. View

14.

Romagnoli E, Mascia M, Cipriani C, Fassino V, Mazzei F, DErasmo E . Short and long-term variations in serum calciotropic hormones after a single very large dose of ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) in the elderly. J Clin Endocrinol Metab. 2008; 93(8):3015-20. DOI: 10.1210/jc.2008-0350. View

15.

Liu J, Xie H, Ye Z, Li F, Wang L . Rates, predictors, and mortality of sepsis-associated acute kidney injury: a systematic review and meta-analysis. BMC Nephrol. 2020; 21(1):318. PMC: 7393862. DOI: 10.1186/s12882-020-01974-8. View

16.

Chen J, Yun C, He Y, Piao J, Yang L, Yang X . Vitamin D status among the elderly Chinese population: a cross-sectional analysis of the 2010-2013 China national nutrition and health survey (CNNHS). Nutr J. 2017; 16(1):3. PMC: 5237548. DOI: 10.1186/s12937-016-0224-3. View

17.

Poston J, Koyner J . Sepsis associated acute kidney injury. BMJ. 2019; 364:k4891. PMC: 6890472. DOI: 10.1136/bmj.k4891. View

18.

Austin P . Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009; 28(25):3083-107. PMC: 3472075. DOI: 10.1002/sim.3697. View

19.

Lee P, Eisman J, Center J . Vitamin D deficiency in critically ill patients. N Engl J Med. 2009; 360(18):1912-4. DOI: 10.1056/NEJMc0809996. View

20.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View