Abstract
ABSTRACTAim:Current guidelines do not address between-person variability in markers of bone and mineral metabolism across subgroups of patients, nor delineate treatment strategies based upon such factors.Methods:A cross sectional study was carried out to analyze data from 20,494 United States Veterans and verify the variability of Vitamin D (25(OH)D) and parathyroid hormone (PTH) levels across race and stage of chronic kidney disease.Results:PTH levels were higher in Black Americans (BA) than White Americans (WA) at all levels of 25(OH)D and across eGFR strata. There was a progressive decline in PTH levels from the lowest (25(OH)D < 20) to highest quartile (25(OH)D >=40) in both BA (134.4 v 90 pg/mL, respectively) and WA (112.5 v 71.62 pg/mL) (p<0.001 for all comparisons).Conclusion:In this analysis, higher than normal 25(OH)D levels were well tolerated and associated with lower parathyroid hormone values in both blacks and whites. Black Americans had higher PTH values at every level of eGFR and 25(OH)D levels suggesting a single PTH target is not appropriate.
Highlights
Established treatments for secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) include phosphate binders, calcimimetics, and vitamin D sterols[1,2,3]
There was a significant increase in age as 25(OH)D levels increased in both Black Americans (BA) and White Americans (WA); at each quartile of 25(OH) D, WA were older than BA (p< 0.001)
The current analysis suggests that in CKD stage 3, higher than normal 25(OH)D levels are associated with lower parathyroid hormone (PTH) levels
Summary
Established treatments for secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) include phosphate binders, calcimimetics, and vitamin D sterols[1,2,3]. Resultados: os níveis de PTH foram maiores em americanos negros (AN) do que em americanos brancos (AB) em todos os níveis de 25 (OH) D e em todos os estratos de TFGe. Houve um declínio progressivo nos níveis de PTH do quartil mais baixo (25 (OH) D = 40) em AN (134,4 v 90 pg/mL, respectivamente) e AB (112,5 v 71,62 pg/mL) (p
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