Vitamin D deficiency and treatment versus risk of infection in end-stage renal disease patients under dialysis : a systematic review and meta-analysis

Su, Guobin; Liu, Zhuangzhu; Qin, Xindong; Hong, Xu; Liu, Xusheng; Wen, Zehuai; Lindholm, Bengt; Carrero, Juan-Jesus; Johnson, David W.; Brusselaers, Nele; Lundborg, Cecilia Stålsby

doi:10.1093/NDT/GFY216

Title

Vitamin D deficiency and treatment versus risk of infection in end-stage renal disease patients under dialysis : a systematic review and meta-analysis

Author

Su, Guobin

Liu, Zhuangzhu

Qin, Xindong

Hong, Xu

Liu, Xusheng

Wen, Zehuai

Lindholm, Bengt

Carrero, Juan-Jesus

Johnson, David W.

Brusselaers, Nele

Lundborg, Cecilia Stålsby

Abstract

Background. Infections are common and can be fatal in patients undergoing long-term dialysis. Recent studies have shown conflicting evidence associating infection with vitamin D status or use of vitamin D and have not been systematically reviewed in this population. Methods. We searched PubMed, Web of Science, Cochrane Library, Embase and three Chinese databases from inception until December 2017 for interventional [non-randomized or randomized controlled trials (RCTs)], cohort and case-control studies on levels of serum 25-hydroxyvitamin 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 (RR) of infection and level of 25(OH) D or use of vitamin D. Results. Of 2440 reports identified, 17 studies met inclusion criteria, all with moderate quality, with 6 cohort studies evaluating 25(OH) D serum concentrations (n = 5714) 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% confidence interval (CI) 0.41-0.89]} in the subjects with high or normal levels of 25(OH) D than in those with low levels. When compared with 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)]. Conclusions. High or normal serum levels of 25(OH) D and the use of vitamin D, particularly VDRA, were each associated with a lower risk of composite infection in long-term dialysis patients.

Language

English

Source (journal)

Nephrology, dialysis, transplantation. - Berlin

Publication

Oxford : Oxford univ press , 2019

ISSN

0931-0509

DOI

10.1093/NDT/GFY216

Volume/pages

34 :1 (2019) , p. 146-156