Independent Association of Circulating Vitamin D Metabolites with Anemia Risk in Patients Scheduled for Cardiac Surgery

Background Preoperative anemia is considered an independent risk factor of poor clinical outcome in cardiac surgical patients. Low vitamin D status may increase anemia risk. Methods We investigated 3,615 consecutive patients scheduled for cardiac surgery to determine the association between preoperative anemia (hemoglobin [Hb] < 12.5 g/dL) and circulating levels of the vitamin D metabolites 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25[OH](2)D). Results Of the study cohort, 27.8% met the criteria for anemia. In patients with deficient 25OHD levels (<30 nmol/l) mean Hb concentrations were 0.5 g/dL lower than in patients with adequate 25OHD levels (50.0-125 nmol/l; P<0.001). Regarding 1,25(OH)(2)D, mean Hb concentrations were 1.2 g/dL lower in the lowest 1,25(OH)(2)D category (<40 pmol/l) than in the highest 1,25(OH)(2)D category (>70 pmol/l; P<0.001). In multivariable-adjusted logistic regression analyses, the odds ratios for anemia of the lowest categories of 25OHD and 1,25(OH)(2)D were 1.48 (95% CI: 1.19-1.83) and 2.35 (95% CI: 1.86-2.97), compared with patients who had adequate 25OHD levels and 1,25(OH)(2)D values in the highest category, respectively. Anemia risk was greatest in patients with dual deficiency of 25OHD and 1,25(OH)(2)D (multivariable-adjusted OR = 3.60 (95% CI: 2.40-5.40). Prevalence of deficient 25OHD levels was highest in anemia of nutrient deficiency, whereas low 1,25(OH)(2)D levels were most frequent in anemia of chronic kidney disease. Conclusion This cross-sectional study demonstrates an independent inverse association between vitamin D status and anemia risk. If confirmed in clinical trials, preoperative administration of vitamin D or activated vitamin D (in case of chronic kidney disease) would be a promising strategy to prevent anemia in patients scheduled for cardiac surgery.