Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients

Melissa Soohoo, Seyed Foad Ahmadi, Hemn Qader, Elani Streja, Yoshitsugu Obi, Hamid Moradi, Connie M. Rhee, Tae Hee Kim, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

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Abstract

Background: Vitamin B12 (B12) and folate are essential vitamins that play important roles in physiological processes. In the general population, many studies have evaluated the association of these vitamins with clinical outcomes, yet this association in hemodialysis (HD) patients remains unclear. Methods: We examined the association of serum folate and B12 with mortality in a 5-year cohort of 9517 (folate) and 12 968 (B12) HD patients using Cox models with hierarchical adjustment for sociodemographics, comorbidities, and laboratory variables associated with the malnutrition and inflammation complex syndrome. The associations of baseline B12 and folate (separately) with all-cause mortality were evaluated across five categories of B12 [<400 (reference), 400-<550, 550-<650, 650-<750 and 750 pg/mL] and folate [<6.2, 6.2-<8.4, 8.4- <11 (reference), 11-<14.3 and 14.3 ng/mL]. Results: The study cohort with B12 measurements had a mean 6 standard deviation age of 63 6 15 years, among whom 43% were female, 33% were African-American, and 57% were diabetic. Higher B12 concentrations 550 pg/mL were associated with a higher risk of mortality after adjusting for sociodemographic and laboratory variables. However, only lower serum folate concentrations <6.2 ng/mL were associated with a higher risk of all-cause mortality when adjusted for sociodemographic variables [adjusted hazard ratio (95% confidence-interval): 1.18 (1.03-1.35)]. Conclusions: Higher B12 concentrations are associated with higher all-cause mortality in HD patients independent of sociodemographics and laboratory variables, whereas lower folate concentrations were associated with higher all-cause mortality after accounting for sociodemographic variables. Further studies are warranted to determine the optimal B12 and folate level targets in this population.

Original languageEnglish (US)
Pages (from-to)1024-1032
Number of pages9
JournalNephrology Dialysis Transplantation
Volume32
Issue number6
DOIs
StatePublished - Jan 1 2017

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Vitamin B 12
Folic Acid
Renal Dialysis
Mortality
Serum
Vitamins
Physiological Phenomena
Health Services Needs and Demand
Proportional Hazards Models
Malnutrition
African Americans
Comorbidity
Cohort Studies
Confidence Intervals
Inflammation
Population

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Soohoo, M., Ahmadi, S. F., Qader, H., Streja, E., Obi, Y., Moradi, H., ... Kalantar-Zadeh, K. (2017). Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients. Nephrology Dialysis Transplantation, 32(6), 1024-1032. https://doi.org/10.1093/ndt/gfw090

Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients. / Soohoo, Melissa; Ahmadi, Seyed Foad; Qader, Hemn; Streja, Elani; Obi, Yoshitsugu; Moradi, Hamid; Rhee, Connie M.; Kim, Tae Hee; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Nephrology Dialysis Transplantation, Vol. 32, No. 6, 01.01.2017, p. 1024-1032.

Research output: Contribution to journalArticle

Soohoo, M, Ahmadi, SF, Qader, H, Streja, E, Obi, Y, Moradi, H, Rhee, CM, Kim, TH, Kovesdy, C & Kalantar-Zadeh, K 2017, 'Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients', Nephrology Dialysis Transplantation, vol. 32, no. 6, pp. 1024-1032. https://doi.org/10.1093/ndt/gfw090
Soohoo, Melissa ; Ahmadi, Seyed Foad ; Qader, Hemn ; Streja, Elani ; Obi, Yoshitsugu ; Moradi, Hamid ; Rhee, Connie M. ; Kim, Tae Hee ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients. In: Nephrology Dialysis Transplantation. 2017 ; Vol. 32, No. 6. pp. 1024-1032.
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abstract = "Background: Vitamin B12 (B12) and folate are essential vitamins that play important roles in physiological processes. In the general population, many studies have evaluated the association of these vitamins with clinical outcomes, yet this association in hemodialysis (HD) patients remains unclear. Methods: We examined the association of serum folate and B12 with mortality in a 5-year cohort of 9517 (folate) and 12 968 (B12) HD patients using Cox models with hierarchical adjustment for sociodemographics, comorbidities, and laboratory variables associated with the malnutrition and inflammation complex syndrome. The associations of baseline B12 and folate (separately) with all-cause mortality were evaluated across five categories of B12 [<400 (reference), 400-<550, 550-<650, 650-<750 and 750 pg/mL] and folate [<6.2, 6.2-<8.4, 8.4- <11 (reference), 11-<14.3 and 14.3 ng/mL]. Results: The study cohort with B12 measurements had a mean 6 standard deviation age of 63 6 15 years, among whom 43{\%} were female, 33{\%} were African-American, and 57{\%} were diabetic. Higher B12 concentrations 550 pg/mL were associated with a higher risk of mortality after adjusting for sociodemographic and laboratory variables. However, only lower serum folate concentrations <6.2 ng/mL were associated with a higher risk of all-cause mortality when adjusted for sociodemographic variables [adjusted hazard ratio (95{\%} confidence-interval): 1.18 (1.03-1.35)]. Conclusions: Higher B12 concentrations are associated with higher all-cause mortality in HD patients independent of sociodemographics and laboratory variables, whereas lower folate concentrations were associated with higher all-cause mortality after accounting for sociodemographic variables. Further studies are warranted to determine the optimal B12 and folate level targets in this population.",
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T1 - Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients

AU - Soohoo, Melissa

AU - Ahmadi, Seyed Foad

AU - Qader, Hemn

AU - Streja, Elani

AU - Obi, Yoshitsugu

AU - Moradi, Hamid

AU - Rhee, Connie M.

AU - Kim, Tae Hee

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: Vitamin B12 (B12) and folate are essential vitamins that play important roles in physiological processes. In the general population, many studies have evaluated the association of these vitamins with clinical outcomes, yet this association in hemodialysis (HD) patients remains unclear. Methods: We examined the association of serum folate and B12 with mortality in a 5-year cohort of 9517 (folate) and 12 968 (B12) HD patients using Cox models with hierarchical adjustment for sociodemographics, comorbidities, and laboratory variables associated with the malnutrition and inflammation complex syndrome. The associations of baseline B12 and folate (separately) with all-cause mortality were evaluated across five categories of B12 [<400 (reference), 400-<550, 550-<650, 650-<750 and 750 pg/mL] and folate [<6.2, 6.2-<8.4, 8.4- <11 (reference), 11-<14.3 and 14.3 ng/mL]. Results: The study cohort with B12 measurements had a mean 6 standard deviation age of 63 6 15 years, among whom 43% were female, 33% were African-American, and 57% were diabetic. Higher B12 concentrations 550 pg/mL were associated with a higher risk of mortality after adjusting for sociodemographic and laboratory variables. However, only lower serum folate concentrations <6.2 ng/mL were associated with a higher risk of all-cause mortality when adjusted for sociodemographic variables [adjusted hazard ratio (95% confidence-interval): 1.18 (1.03-1.35)]. Conclusions: Higher B12 concentrations are associated with higher all-cause mortality in HD patients independent of sociodemographics and laboratory variables, whereas lower folate concentrations were associated with higher all-cause mortality after accounting for sociodemographic variables. Further studies are warranted to determine the optimal B12 and folate level targets in this population.

AB - Background: Vitamin B12 (B12) and folate are essential vitamins that play important roles in physiological processes. In the general population, many studies have evaluated the association of these vitamins with clinical outcomes, yet this association in hemodialysis (HD) patients remains unclear. Methods: We examined the association of serum folate and B12 with mortality in a 5-year cohort of 9517 (folate) and 12 968 (B12) HD patients using Cox models with hierarchical adjustment for sociodemographics, comorbidities, and laboratory variables associated with the malnutrition and inflammation complex syndrome. The associations of baseline B12 and folate (separately) with all-cause mortality were evaluated across five categories of B12 [<400 (reference), 400-<550, 550-<650, 650-<750 and 750 pg/mL] and folate [<6.2, 6.2-<8.4, 8.4- <11 (reference), 11-<14.3 and 14.3 ng/mL]. Results: The study cohort with B12 measurements had a mean 6 standard deviation age of 63 6 15 years, among whom 43% were female, 33% were African-American, and 57% were diabetic. Higher B12 concentrations 550 pg/mL were associated with a higher risk of mortality after adjusting for sociodemographic and laboratory variables. However, only lower serum folate concentrations <6.2 ng/mL were associated with a higher risk of all-cause mortality when adjusted for sociodemographic variables [adjusted hazard ratio (95% confidence-interval): 1.18 (1.03-1.35)]. Conclusions: Higher B12 concentrations are associated with higher all-cause mortality in HD patients independent of sociodemographics and laboratory variables, whereas lower folate concentrations were associated with higher all-cause mortality after accounting for sociodemographic variables. Further studies are warranted to determine the optimal B12 and folate level targets in this population.

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