Use of vitamin D and infection in patients with chronic kidney disease

To evaluate the effectiveness of vitamin D supplementation as protection factor against infection of patients with chronic kidney disease on conservative treatment.

Method:

Retrospective cohort study carried out between 2013 and 2016 in the Conservative Treatment Outpatient Clinics (Ambulatório de Tratamento Conservador) of the Hypertension and Kidney Hospital (Hospital do Rim e Hipertensão) of the Universidade Federal de São Paulo. Data on sociodemographic factors, comorbidity, infection episodes and use or nonuse of vitamin D supplementation for at least 6 months were collected from medical records. The primary outcomes considered in both groups were: presence or absence of infection anywhere on the body (bloodstream, urinary, respiratory and surgical sites).

Results:

A total of 263 patients were included and those who received (n=43) vitamin D had 59% less chance of developing infections (OR=0.41; 95%CI; 0.15-0.99), when compared to those who did not receive.

Conclusion:

Vitamin D supplementation was a protective factor against infections of all causes.

Descriptors:
Renal Insufficiency; Conservative Treatment; Vitamin D; Infection; Nephrology

Variables	n	%
Sex
Male	139	52.85
Female	124	47.14
Age group
18-33	13	4.94
34-49	21	7.98
50-65	77	29.28
66 or older	149	56.65
Without information	3	1.14
Race
White	159	60.46
Black	84	31.94
Without information	20	7.60
Occupation
Retired patients/pensioners	55	20.21
Other	116	44.11
Without information	92	34.99
Comorbidities
Diabetes mellitus	119	45.25
High blood pressure	232	88.21
Cardiovascular diseases	57	21.67
Other	183	69.58

Variables	Use of Vitamin D	Nonuse of Vitamin D	Total (n)	%	Proportion Exposure
With infection	7	71	78	29.65	0.1628
Without infection	36	149	185	70.34	0.3237
Total	43	220	263	100	0.2966

Site	Use of Vitamin D	Nonuse of Vitamin D	Total
Site	Use of Vitamin D	Nonuse of Vitamin D	n	%
Bloodstream infection	2	5	7	8.97
Urinary tract infection	3	65	68	87.18
Respiratory tract infection	2	1	3	3.85
Total	07	71	78	100

Microorganisms	Urinary tract infection	Respiratory tract infection	Total
Microorganisms	Urinary tract infection	Respiratory tract infection	n	%
Gram-positive bacteria
Staphylococcus aureus	1		1	1.41
Coagulase-negative staphylococcus	1		1	1.41
Enterococcus spp.	4		4	5.63
Gram-negative bacteria
Escherichia coli	35	1	36	50.70
Klebsiella pneumoniae	12		12	16.90
Klebsiella oxytoca	1		1	1.41
Morganella morganii	1		1	1.41
Proteus mirabilis	3		3	4.23
Pseudomonas aeruginosa	1		1	1.41
Enterobacter spp.	3		3	4.23
Culture not available	6	2	8	11.26
Total	68	3	71	100

	Infection		OR (95%CI)	p value	OR (95%CI)	p value
	Yes	No	OR (95%CI)	p value	OR (95%CI)	p value
Sex
Female	43	86	1
Male	35	99	0.71 (0.40-1.24)	0.20	0.64 (0.37-1.11)	0.11
Age group
18-33	1	12	1
34-49	8	13	7.38 (0.75-354.38)	0.05	8.97 (0.92-87.41)	0.06
50-65	19	58	3.93 (0.51-176.72)	0.17	4.12 (0.48-35.55)	0.20
66 or older	50	99	6.06 (0.85-264.12)	0.05	6.04 (0.73-50.15)	0.10
Race
White	44	115	1
Black	23	61	0.99 (0.52-1.85)	0.96	1.00 (0.54-1.83)	0.99
Ignored	11	9	3.19 (1.11-9.31)	0.01	3.07 (1.15-8.18)	0.03
Diabetes mellitus
No	42	102	1
Yes	36	83	1.05 (0.60-1.85)	0.85
High blood pressure
No	9	21	1
Yes	69	164	0.98 (0.41-2.56)	0.97
Cardiovascular disease
No	57	148	1
Yes	21	37	1.47 (0.75-2.84)	0.22
Use of vitamin D
No	71	149	1
Yes	7	36	0.41 (0.15-0.99)	0.03	0.48 (0.20-1.15)	0.10

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR Dulce Aparecida Barbosa E-mail: dulce.barbosa@unifesp.br