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Mineral metabolites and CKD progression in African Americans

Julia J Scialla1, Brad C Astor, Tamara Isakova

  • 1Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.

Journal of the American Society of Nephrology : JASN
|December 18, 2012
PubMed

Insights

Mineral metabolism abnormalities worsen in African Americans with chronic kidney disease (CKD). Higher fibroblast growth factor-23 (FGF23), parathyroid hormone (PTH), and phosphate levels are linked to increased risk of end-stage renal disease (ESRD) or death.

Area of Science:

  • Nephrology
  • Endocrinology
  • Public Health

Background:

  • Chronic kidney disease (CKD) disproportionately affects African Americans, progressing faster to end-stage renal disease (ESRD).
  • Disordered mineral metabolism is more severe in African Americans with CKD, potentially explaining disease acceleration.

Purpose of the Study:

  • To evaluate longitudinal changes in fibroblast growth factor-23 (FGF23), parathyroid hormone (PTH), phosphate, and 25-hydroxyvitamin D in African Americans with CKD.
  • To examine the association of baseline mineral metabolite levels with the risk of ESRD or death.

Main Methods:

  • Analysis of data from the African American Study of Kidney Disease and Hypertension.
  • Longitudinal assessment of serum FGF23, PTH, phosphate, and 25-hydroxyvitamin D in 420 participants over a median of 4 years.
  • Examination of baseline mineral metabolite associations with ESRD or death risk in 809 participants.

Main Results:

  • Serum FGF23, PTH, and phosphate levels increased over time, with the greatest increases seen in participants with faster GFR decline.
  • Higher baseline FGF23, PTH, and phosphate levels independently associated with increased risk for ESRD or death, irrespective of GFR.
  • FGF23 showed a dose-response relationship with outcomes, while PTH and phosphate exhibited nonlinear associations. Vitamin D insufficiency was prevalent but not independently associated with outcomes.

Conclusions:

  • Abnormalities in mineral metabolism exacerbate with CKD progression in African Americans.
  • Worsening mineral metabolism is associated with a higher risk of ESRD among African Americans with hypertensive nephrosclerosis.

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