Association between 25-hydroxyvitamin d and cardiac troponin t level in korean esrd patients

Abstract

Growing evidences have shown that 25-hydroxyvitamin D [25(OH)D] deficiency may be associated with cardiovascular (CV) mortality in ESRD patients. However, it has not been sufficiently investigated in the Northeast Asian ESRD population. From 2009 to 2011, 208 patients have newly commenced renal replacement therapy (RRT) in our unit. Among them, 136 patients who were measured for 25(OH)D and cardiac troponin T (cTnT) level at the start of RRT were analyzed (M:F=74:62, Age 54.1±14.7 yrs, DM 53.7%). The patient experienced coronary artery disease within 3 months was excluded. Patients divided into 3 groups according to cTnT level: group 1 (n=36), cTnT not detected (<0.01 ng/ml); group 2 (n=64), 0.01≤cTnT<0.1 ng/ml; group 3 (n=36), cTnT≥0.1 ng/ml. Median 25(OH)D levels were 12.1 ng/ml (IQR, 8.9−15.9), 10.4 (5.6−15.5) and 6.6 (4.1−10.2), respectively (p<0.001). Median 1,25-dihydroxyvitamin D [1,25(OH)2D] levels were 19.3 pg/ml (IQR, 13.0−23.7), 17.1 (10.7−21.5) and 11.6 (7.9−20.1), respectively (p=0.040). Old age, male sex, presence of DM, low hemoglobin, low serum albumin, high phosphorous, high C-reactive protein level, high mean arterial pressure, low ejection fraction and high left ventricular filling pressure (E/E’) were also frequent in higher cTnT group in simple analysis. Using cut point of cTnT level≥0.1 ng/ml, which was known as a valuable predictor of all-cause and CV mortality in many studies, multiple logistic regression analysis was undertaken for adjusting interaction among independent variables. After adjusting confounding factors, log25(OH)D was independently associated with elevated cTnT level (OR, 0.148; 95% CI, 0.026 to 0.832). Male sex and presence of DM were also significant independent variables (OR, 5.025; 95% CI, 1.566 to 16.125 and OR, 4.278; 95% CI, 1.315 to 13.915, respectively). However, other variables, including log1,25(OH)2D did not show significance in this regression model. In conclusion, low 25(OH)D level was associated with elevated cTnT level even in Korean ESRD patients, suggesting 25(OH)D deficiency partly plays a role in poor CV outcome in this population like Western population.