1. Racial Differences in Markers of Mineral Metabolism in Advanced Chronic Kidney Disease
- Author
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Jessica Kendrick, Alfred K. Cheung, Anna Jovanovich, Tom Greene, Michel Chonchol, William L. Roberts, Gerard Smits, and James S. Kaufman
- Subjects
Fibroblast growth factor 23 ,Male ,medicine.medical_specialty ,Homocysteine ,Epidemiology ,medicine.medical_treatment ,Urology ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,Bone and Bones ,White People ,End stage renal disease ,chemistry.chemical_compound ,Metabolic Diseases ,Interquartile range ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,Prospective Studies ,Vitamin D ,Prospective cohort study ,Dialysis ,Aged ,Transplantation ,Chi-Square Distribution ,business.industry ,Original Articles ,Middle Aged ,medicine.disease ,United States ,Black or African American ,Fibroblast Growth Factors ,Fibroblast Growth Factor-23 ,Endocrinology ,Cross-Sectional Studies ,chemistry ,Nephrology ,Parathyroid Hormone ,Chronic Disease ,Multivariate Analysis ,Linear Models ,Kidney Failure, Chronic ,Female ,Kidney Diseases ,business ,Biomarkers ,Kidney disease - Abstract
Summary Background and objectives This study examined differences in the concentration of markers of mineral metabolism across race in patients with advanced CKD not requiring dialysis and ESRD. Design, setting, participants, & measurements Concentrations of 25-hydroxyvitamin D (25(OH)D), 1,25dihydroxyvitamin D (1,25(OH)2D), intact parathyroid hormone (iPTH), and fibroblast growth factor 23 (FGF-23) were measured in stored plasmasamples of 1497 patients with advanced CKD not yet on dialysis and ESRD who participated in the Homocysteine in Kidney and End Stage Renal Disease study. Linear regression models were used to examine the relationship between race and 25(OH)D, 1,25(OH)2D, iPTH, and FGF-23 concentrations. ResultsNon-Hispanic white patients comprised 58% of the cohort, whereas non-Hispanic blacks comprised 42%. Median (interquartile range) FGF-23 concentrations were lower in blacks compared with whites with CKD (323 [181–655] versus 431 [232–1026] RU/ml; P,0.001) but not in ESRD. In adjusted linear regression models, blacks with CKD not requiring dialysis had significantly lower plasma FGF-23 concentrations (difference, 2159; 95% confidence interval, 2205 to 2106; P,0.001) compared with whites, independent of plasma 25(OH)D, 1,25(OH)2D, and iPTH concentrations. This difference was not observed in the ESRD group. The magnitude of correlation for the relationships between 1,25(OH)2D with iPTH, FGF-23 with 1,25(OH)2D, and FGF-23 with iPTH were stronger among blacks than whites with CKD not requiring dialysis. Conclusions In advanced CKD not requiring dialysis, blacks have lower FGF-23 concentrations than whites. Blacks with CKD and ESRD have lower 25(OH)D and higher iPTH compared with whites, independent of FGF-23 concentrations. Clin J Am Soc Nephrol 7: 640–647, 2012. doi: 10.2215/CJN.07020711
- Published
- 2012