Low Serum Levels of Vitamin D are Associated with Progression of Subclinical Atherosclerotic Vascular Disease in Peritoneal Dialysis Patients: A Prospective, Multicenter Study

• Published in: Nephron (2015) Vol. 136; no. 2; p. 111
• Main Authors: Pérez Fontán, Miguel, Borràs Sans, Mercè, Bajo Rubio, Maria Auxiliadora, Rodriguez-Carmona, Ana, Betriu, Angels, Valdivielso, José Maria, Fernández, Elvira
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-2017
• Subjects: Adult; Aged; Biomarkers - blood; Disease Progression; End Stage Liver Disease - complications; End Stage Liver Disease - therapy; Female; Humans; Longitudinal Studies; Male; Middle Aged; Peritoneal Dialysis - adverse effects; Plaque, Atherosclerotic - blood; Plaque, Atherosclerotic - complications; Prospective Studies; Ultrasonography; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Vitamin D; Carotid atherosclerosis; Peritoneal dialysis
• DOI: 10.1159/000458418
• EISSN: 2235-3186

The prevalence of subclinical atherosclerosis and the main predictors of progression of this condition in patients undergoing peritoneal dialysis (PD) have been insufficiently investigated.
Following a prospective, multicenter, observational design, we studied 237 patients who were treated with PD for ≥3 months, without any clinical background of cardiovascular (CV) disease. Our objectives were the following: (1) to investigate the prevalence of subclinical atherosclerosis, as compared to a control group of age- and sex-matched healthy individuals, and (2) to disclose PD technique-related predictors of progression of disease during a 24-month follow-up period. We used vascular ultrasound for characterization of subclinical atherosclerotic disease.
A total of 123 patients (51.9%) vs. 79 controls (33.5%) presented ≥1 carotid plaque, and 114 patients (48.3%) vs. 72 controls (30.5%) ≥1 femoral plaque, at baseline evaluation (p < 0.0005). Progression of disease, either in clinical or ultrasound (new plaques) terms, affected 62.6% of patients. Multivariate analysis identified age, carotid intima-media thickness, presence of ≥1 carotid plaque, and serum levels of 25OH vitamin D and C-reactive protein (CRP) at baseline as independent correlates of progression of atherosclerotic disease. On the contrary, PD technique-related variables did not show any association with this outcome.
Atherosclerotic vascular disease is frequent among asymptomatic patients undergoing PD. Older age, pre-existent disease (assessed by vascular ultrasound), and serum levels of 25OH vitamin D and CRP are independent markers of the progression of this condition. These findings may contribute to improve identification of subpopulations with a high risk of CV events, deserving intensified measures of prevention.