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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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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.
Keywords
25-hydroxyvitamin D, dialysis, hospitalization, infection, mortality, vitamin D receptor activator, CHRONIC KIDNEY-DISEASE, RESPIRATORY-TRACT INFECTIONS, D-RECEPTOR ACTIVATOR, SERUM 25-HYDROXYVITAMIN D, D SUPPLEMENTATION, HEMODIALYSIS-PATIENTS, MORTALITY RISK, SURVIVAL, OUTCOMES, DEATH

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Citation

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MLA
Su, Guobin, et al. “Vitamin D Deficiency and Treatment versus Risk of Infection in End-Stage Renal Disease Patients under Dialysis : A Systematic Review and Meta-Analysis.” NEPHROLOGY DIALYSIS TRANSPLANTATION, vol. 34, no. 1, 2019, pp. 146–56.
APA
Su, G., Liu, Z., Qin, X., Hong, X., Liu, X., Wen, Z., … Lundborg, C. S. (2019). Vitamin D deficiency and treatment versus risk of infection in end-stage renal disease patients under dialysis : a systematic review and meta-analysis. NEPHROLOGY DIALYSIS TRANSPLANTATION, 34(1), 146–156.
Chicago author-date
Su, Guobin, Zhuangzhu Liu, Xindong Qin, Xu Hong, Xusheng Liu, Zehuai Wen, Bengt Lindholm, et al. 2019. “Vitamin D Deficiency and Treatment versus Risk of Infection in End-Stage Renal Disease Patients under Dialysis : A Systematic Review and Meta-Analysis.” NEPHROLOGY DIALYSIS TRANSPLANTATION 34 (1): 146–56.
Chicago author-date (all authors)
Su, Guobin, Zhuangzhu Liu, Xindong Qin, Xu Hong, Xusheng Liu, Zehuai Wen, Bengt Lindholm, Juan-Jesus Carrero, David W Johnson, Nele Brusselaers, and Cecilia Stalsby Lundborg. 2019. “Vitamin D Deficiency and Treatment versus Risk of Infection in End-Stage Renal Disease Patients under Dialysis : A Systematic Review and Meta-Analysis.” NEPHROLOGY DIALYSIS TRANSPLANTATION 34 (1): 146–156.
Vancouver
1.
Su G, Liu Z, Qin X, Hong X, Liu X, Wen Z, et al. Vitamin D deficiency and treatment versus risk of infection in end-stage renal disease patients under dialysis : a systematic review and meta-analysis. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2019;34(1):146–56.
IEEE
[1]
G. Su et al., “Vitamin D deficiency and treatment versus risk of infection in end-stage renal disease patients under dialysis : a systematic review and meta-analysis,” NEPHROLOGY DIALYSIS TRANSPLANTATION, vol. 34, no. 1, pp. 146–156, 2019.
@article{8622091,
  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.},
  author       = {Su, Guobin and Liu, Zhuangzhu and Qin, Xindong and Hong, Xu and Liu, Xusheng and Wen, Zehuai and Lindholm, Bengt and Carrero, Juan-Jesus and Johnson, David W and Brusselaers, Nele and Lundborg, Cecilia Stalsby},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keywords     = {25-hydroxyvitamin D,dialysis,hospitalization,infection,mortality,vitamin D receptor activator,CHRONIC KIDNEY-DISEASE,RESPIRATORY-TRACT INFECTIONS,D-RECEPTOR ACTIVATOR,SERUM 25-HYDROXYVITAMIN D,D SUPPLEMENTATION,HEMODIALYSIS-PATIENTS,MORTALITY RISK,SURVIVAL,OUTCOMES,DEATH},
  language     = {eng},
  number       = {1},
  pages        = {146--156},
  title        = {Vitamin D deficiency and treatment versus risk of infection in end-stage renal disease patients under dialysis : a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1093/ndt/gfy216},
  volume       = {34},
  year         = {2019},
}

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