Effect of oral vitamin D analogs on mortality and cardiovascular outcomes among adults with chronic kidney disease: A meta-analysis

Michelle C. Mann, Amy J. Hobbs, Brenda R. Hemmelgarn, Derek J. Roberts, Sofia B. Ahmed, Doreen M. Rabi

Research output: Contribution to journalArticle

Abstract

Background Vitamin D deficiency is highly prevalent in patients with chronic kidney disease (CKD) and has been associated with all-cause and cardiovascular mortality in observational studies. However, evidence from randomized controlled trials (RCTs) supporting vitamin D supplementation is lacking. We sought to assess whether vitamin D supplementation alters the relative risk (RR) of all-cause and cardiovascular mortality, as well as serious adverse cardiovascular events, in patients with CKD, compared with placebo. Methods PubMed/MEDLINE, EMBASE, Cochrane Library, and selected nephrology journals and conference proceedings were searched in October 2013. RCTs considered for inclusion were those that assessed oral vitamin D supplementation versus placebo in adults with CKD (â ‰ 60 mL/min/1.73 m 2), including end-stage CKD requiring dialysis. We calculated pooled RR of mortality (all-cause and cardiovascular) and that of cardiovascular events and stratified by CKD stage, vitamin D analog and diabetes prevalence. Results The search identified 4246 articles, of which 13 were included. No significant treatment effect of oral vitamin D on all-cause mortality (RR: 0.84; 95% CI: 0.47, 1.52), cardiovascular mortality (RR: 0.79; 95% CI: 0.26, 2.28) or serious adverse cardiovascular events (RR: 1.20; 95% CI: 0.49, 2.99) was observed. The pooled analysis demonstrated large variation in trials with respect to dosing (0.5 ug-200 000 IU/week) and duration (3-104 weeks). Conclusions Current RCTs do not provide sufficient or precise evidence that vitamin D supplementation affects mortality or cardiovascular risk in CKD. While its effect on biochemical endpoints is well documented, the results demonstrate a lack of appropriate patient-level data within the CKD literature, which warrants larger trials with clinical primary outcomes related to vitamin D supplementation.

Original languageEnglish (US)
Pages (from-to)41-48
Number of pages8
JournalClinical Kidney Journal
Volume8
Issue number1
DOIs
StatePublished - Dec 18 2015
Externally publishedYes

Fingerprint

Chronic Renal Insufficiency
Vitamin D
Meta-Analysis
Mortality
Randomized Controlled Trials
Placebos
Vitamin D Deficiency
Nephrology
PubMed
MEDLINE
Libraries
Chronic Kidney Failure
Observational Studies
Dialysis
Clinical Trials

Keywords

  • cardiovascular outcomes
  • clinical trials
  • meta-analysis
  • mortality
  • vitamin D

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Effect of oral vitamin D analogs on mortality and cardiovascular outcomes among adults with chronic kidney disease : A meta-analysis. / Mann, Michelle C.; Hobbs, Amy J.; Hemmelgarn, Brenda R.; Roberts, Derek J.; Ahmed, Sofia B.; Rabi, Doreen M.

In: Clinical Kidney Journal, Vol. 8, No. 1, 18.12.2015, p. 41-48.

Research output: Contribution to journalArticle

Mann, Michelle C. ; Hobbs, Amy J. ; Hemmelgarn, Brenda R. ; Roberts, Derek J. ; Ahmed, Sofia B. ; Rabi, Doreen M. / Effect of oral vitamin D analogs on mortality and cardiovascular outcomes among adults with chronic kidney disease : A meta-analysis. In: Clinical Kidney Journal. 2015 ; Vol. 8, No. 1. pp. 41-48.
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abstract = "Background Vitamin D deficiency is highly prevalent in patients with chronic kidney disease (CKD) and has been associated with all-cause and cardiovascular mortality in observational studies. However, evidence from randomized controlled trials (RCTs) supporting vitamin D supplementation is lacking. We sought to assess whether vitamin D supplementation alters the relative risk (RR) of all-cause and cardiovascular mortality, as well as serious adverse cardiovascular events, in patients with CKD, compared with placebo. Methods PubMed/MEDLINE, EMBASE, Cochrane Library, and selected nephrology journals and conference proceedings were searched in October 2013. RCTs considered for inclusion were those that assessed oral vitamin D supplementation versus placebo in adults with CKD ({\^a} ‰ 60 mL/min/1.73 m 2), including end-stage CKD requiring dialysis. We calculated pooled RR of mortality (all-cause and cardiovascular) and that of cardiovascular events and stratified by CKD stage, vitamin D analog and diabetes prevalence. Results The search identified 4246 articles, of which 13 were included. No significant treatment effect of oral vitamin D on all-cause mortality (RR: 0.84; 95{\%} CI: 0.47, 1.52), cardiovascular mortality (RR: 0.79; 95{\%} CI: 0.26, 2.28) or serious adverse cardiovascular events (RR: 1.20; 95{\%} CI: 0.49, 2.99) was observed. The pooled analysis demonstrated large variation in trials with respect to dosing (0.5 ug-200 000 IU/week) and duration (3-104 weeks). Conclusions Current RCTs do not provide sufficient or precise evidence that vitamin D supplementation affects mortality or cardiovascular risk in CKD. While its effect on biochemical endpoints is well documented, the results demonstrate a lack of appropriate patient-level data within the CKD literature, which warrants larger trials with clinical primary outcomes related to vitamin D supplementation.",
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T1 - Effect of oral vitamin D analogs on mortality and cardiovascular outcomes among adults with chronic kidney disease

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AU - Rabi, Doreen M.

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AB - Background Vitamin D deficiency is highly prevalent in patients with chronic kidney disease (CKD) and has been associated with all-cause and cardiovascular mortality in observational studies. However, evidence from randomized controlled trials (RCTs) supporting vitamin D supplementation is lacking. We sought to assess whether vitamin D supplementation alters the relative risk (RR) of all-cause and cardiovascular mortality, as well as serious adverse cardiovascular events, in patients with CKD, compared with placebo. Methods PubMed/MEDLINE, EMBASE, Cochrane Library, and selected nephrology journals and conference proceedings were searched in October 2013. RCTs considered for inclusion were those that assessed oral vitamin D supplementation versus placebo in adults with CKD (â ‰ 60 mL/min/1.73 m 2), including end-stage CKD requiring dialysis. We calculated pooled RR of mortality (all-cause and cardiovascular) and that of cardiovascular events and stratified by CKD stage, vitamin D analog and diabetes prevalence. Results The search identified 4246 articles, of which 13 were included. No significant treatment effect of oral vitamin D on all-cause mortality (RR: 0.84; 95% CI: 0.47, 1.52), cardiovascular mortality (RR: 0.79; 95% CI: 0.26, 2.28) or serious adverse cardiovascular events (RR: 1.20; 95% CI: 0.49, 2.99) was observed. The pooled analysis demonstrated large variation in trials with respect to dosing (0.5 ug-200 000 IU/week) and duration (3-104 weeks). Conclusions Current RCTs do not provide sufficient or precise evidence that vitamin D supplementation affects mortality or cardiovascular risk in CKD. While its effect on biochemical endpoints is well documented, the results demonstrate a lack of appropriate patient-level data within the CKD literature, which warrants larger trials with clinical primary outcomes related to vitamin D supplementation.

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