ABSTRACT
Vitamin D deficiency is associated with cardiovascular disease, the most common cause of mortality in hemodialysis patients. To investigate the relation between blood levels of 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) with hemodialysis outcomes, we measured baseline vitamin D levels in a cross-sectional analysis of 825 consecutive patients from within a prospective cohort of incident US hemodialysis patients. Of these patients, 78% were considered vitamin D deficient with 18% considered severely deficient. Calcium, phosphorus, and parathyroid hormone levels correlated poorly with 25D and 1,25D concentrations. To test the association between baseline vitamin D levels and 90-day mortality, we selected the next 175 consecutive participants who died within 90 days and compared them to the 750 patients who survived in a nested case-control analysis. While low vitamin D levels were associated with increased mortality, significant interaction was noted between vitamin D levels, subsequent active vitamin D therapy, and survival. Compared to patients with the highest 25D or 1,25D levels who received therapy, untreated deficient patients were at significantly increased risk for early mortality. Our study shows that among incident hemodialysis patients, vitamin D deficiency is common, correlates poorly with other components of mineral metabolism and is associated with increased early mortality.
Subject(s)
Kidney Failure, Chronic/complications , Kidney Failure, Chronic/mortality , Renal Dialysis/mortality , Vitamin D Deficiency/complications , Vitamin D/metabolism , Aged , Calcium/metabolism , Case-Control Studies , Cohort Studies , Cross-Sectional Studies , Female , Humans , Hyperparathyroidism/drug therapy , Hyperparathyroidism/etiology , Hyperparathyroidism/metabolism , Kidney Failure, Chronic/therapy , Male , Middle Aged , Multivariate Analysis , Parathyroid Hormone/metabolism , Phosphorus/metabolism , Prospective Studies , Risk Factors , Survival Analysis , Vitamin D/analogs & derivatives , Vitamin D/blood , Vitamin D/therapeutic use , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/metabolismABSTRACT
BACKGROUND: Currently, the most precise way of predicting uterine receptivity is the histopathological study through endometrial biopsy. Endometrial morphology and thickness are the factors most strongly associated with better pregnancy rates. OBJECTIVE: To evaluate the prediction value of a numerical grade to predict pregnancy in patients exposed to assisted reproductive techniques. PATIENTS AND METHODS: 22 cycles of in vitro fertilization were made at the Instituto para el Estudio de la Concepción Humana in Monterrey, Nuevo León, from June 2003 to January 2004. We evaluated and categorized: endometrial thickness and morphology, vascularity, miometrial ecogenicity, and uterine artery blood flow (including pulsatility and resistance indexes, presence of protodyastolic nicks, and telediastolic flow). The final numerical grade result from the sum of the individual values obtained for each factor. RESULTS: We included 22 cycles of 20 patients. The general pregnancy and implantation rate was of 40 (8/20) and 26% (17/65) per cycle, respectively. The most common diagnosis was tube occlusion (28%), followed by masculine sex (24%), endometriosis (14%), anovulation (14%), and inexplicable (14%). There were no statistical differences among the pregnant and non-pregnant groups regarding: age, hormonal profile (FSH and estradiol, basal and at the tenth day), total of recombinant FSH unities, follicles > or = 14 mm the day of applying human chorionic gonadotropin, aspired eggs, fertilization index, and transferred embryos. CONCLUSIONS: Endometrial maturity is essential for implantation during an assisted reproductive procedure.
