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

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机构: [1]Global Health–Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, [2]Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Second Affiliated Hospital, Guangzhou University of ChineseMedicine, Guangzhou, Guangdong Province, China, [3]Department of Emergency, Guangdong Provincial Hospital of Chinese Medicine, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China, [4]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, [5]Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of ChineseMedicine, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China, [6]Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden, [7]Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia, [8]Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia, [9]Translational Research Institute, Brisbane, Queensland, Australia and [10]Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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关键词: 25-hydroxyvitamin D dialysis hospitalization infection mortality vitamin D receptor activator

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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.

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出版当年[2018]版:
大类 | 2 区 医学
小类 | 2 区 移植 2 区 泌尿学与肾脏学
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大类 | 2 区 医学
小类 | 2 区 移植 2 区 泌尿学与肾脏学
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Q1 TRANSPLANTATION Q1 UROLOGY & NEPHROLOGY
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Q1 TRANSPLANTATION Q1 UROLOGY & NEPHROLOGY

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第一作者机构: [1]Global Health–Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, [2]Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Second Affiliated Hospital, Guangzhou University of ChineseMedicine, Guangzhou, Guangdong Province, China,
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