Low plasma α-tocopherol concentrations and adverse clinical outcomes in diabetic hemodialysis patients

Clin J Am Soc Nephrol. 2013 Mar;8(3):452-8. doi: 10.2215/CJN.04880511. Epub 2013 Jan 18.


Background and objectives: Trials with the antioxidant vitamin E have failed to show benefit in the general population. Considering the different causes of death in ESRD, this study investigated the association between plasma concentrations of α-tocopherol and specific clinical outcomes in diabetic hemodialysis patients.

Design, settings, participants, & measurements: In 1046 diabetic hemodialysis patients (participants of the German Diabetes and Dialysis Study), α-tocopherol was measured in plasma by reversed-phase HPLC. By Cox regression analyses, hazard ratios were determined for prespecified end points according to baseline plasma α-tocopherol levels: sudden death (n=134), myocardial infarction (n=172), stroke (n=89), combined cardiovascular events (n=398), fatal infection (n=107), and all-cause mortality (n=508).

Results: Patients had a mean age of 66±8 years, and mean plasma α-tocopherol level was 22.8±9.6 µmol/L. Levels of α-tocopherol were highly correlated to triglycerides (r=0.63, P<0.001). Patients in the lowest α-tocopherol quartile had (in unadjusted analyses) a 79% higher risk of stroke and a 31% higher risk of all-cause mortality compared with patients in the highest quartile. The associations were attenuated after adjustment for confounders (hazard ratiostroke=1.56, 95% confidence interval=0.75-3.25; hazard ratiomortality=1.22, 95% confidence interval=0.89-1.69, respectively). There was no association between α-tocopherol and myocardial infarction, sudden death, or infectious death.

Conclusions: Plasma α-tocopherol concentrations were not independently associated with cardiovascular outcomes, infectious deaths, or all-cause mortality in diabetic hemodialysis patients. The lack of association can partly be explained by a confounding influence of malnutrition, which should be considered in the planning of trials to reduce cardiovascular risk in dialysis patients.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cause of Death
  • Chromatography, High Pressure Liquid
  • Chromatography, Reverse-Phase
  • Communicable Diseases / mortality
  • Confounding Factors, Epidemiologic
  • Diabetic Nephropathies / blood*
  • Diabetic Nephropathies / mortality
  • Diabetic Nephropathies / therapy*
  • Down-Regulation*
  • Female
  • Germany
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Malnutrition / mortality
  • Middle Aged
  • Myocardial Infarction / mortality
  • Proportional Hazards Models
  • Prospective Studies
  • Renal Dialysis / adverse effects*
  • Renal Dialysis / mortality
  • Risk Assessment
  • Risk Factors
  • Stroke / mortality
  • Time Factors
  • Treatment Outcome
  • alpha-Tocopherol / blood*


  • Biomarkers
  • alpha-Tocopherol