Impact of race on hyperparathyroidism, mineral disarrays, administered vitamin D mimetic, and survival in hemodialysis patients

Kamyar Kalantar-Zadeh, Jessica E. Miller, Csaba Kovesdy, Rajnish Mehrotra, Lilia R. Lukowsky, Elani Streja, Joni Ricks, Jennie Jing, Allen R. Nissenson, Sander Greenland, Keith C. Norris

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Blacks have high rates of chronic kidney disease, are overrepresented among the US dialysis patients, have higher parathyroid hormone levels, but greater survival compared to nonblacks. We hypothesized that mineral and bone disorders (MBDs) have a bearing on survival advantages of black hemodialysis patients. In 139,328 thrice-weekly treated hemodialysis patients, including 32% blacks, in a large dialysis organization, where most laboratory values were measured monthly for up to 60 months (July 2001 to June 2006), we examined differences across races in measures of MBDs and survival predictabilities of these markers and administered the active vitamin D medication paricalcitol. Across each age increment, blacks had higher serum calcium and parathyroid hormone (PTH) levels and almost the same serum phosphorus and alkaline phosphatase levels and were more likely to receive injectable active vitamin D in the dialysis clinic, mostly paricalcitol, at higher doses than nonblacks. Racial differences existed in mortality predictabilities of different ranges of serum calcium, phosphorus, and PTH but not alkaline phosphatase. Blacks who received the highest dose of paricalcitol (>10μg/week) had a demonstrable survival advantage over nonblacks (case-mix-adjusted death hazard ratio=0.87, 95% confidence level 0.83-0.91) compared with those who received lower doses (<10μg/week) or no active vitamin D. Hence, in black hemodialysis patients, hyperparathyroidism and hypercalcemia are more prevalent than in nonblacks, whereas hyperphosphatemia or hyperphosphatasemia are not. Survival advantages of blacks appear restricted to those receiving higher doses of active vitamin D. Examining the effect of MBD modulation on racial survival disparities of hemodialysis patients is warranted.

Original languageEnglish (US)
Pages (from-to)2448-2458
Number of pages11
JournalJournal of Bone and Mineral Research
Volume25
Issue number12
DOIs
StatePublished - Dec 1 2010

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Hyperparathyroidism
Vitamin D
Minerals
Renal Dialysis
Survival
Parathyroid Hormone
Dialysis
Bone and Bones
Phosphorus
Alkaline Phosphatase
Serum
Calcium
Hyperphosphatemia
Diagnosis-Related Groups
Hypercalcemia
Chronic Renal Insufficiency
Organizations
Injections
Mortality
paricalcitol

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

Cite this

Impact of race on hyperparathyroidism, mineral disarrays, administered vitamin D mimetic, and survival in hemodialysis patients. / Kalantar-Zadeh, Kamyar; Miller, Jessica E.; Kovesdy, Csaba; Mehrotra, Rajnish; Lukowsky, Lilia R.; Streja, Elani; Ricks, Joni; Jing, Jennie; Nissenson, Allen R.; Greenland, Sander; Norris, Keith C.

In: Journal of Bone and Mineral Research, Vol. 25, No. 12, 01.12.2010, p. 2448-2458.

Research output: Contribution to journalArticle

Kalantar-Zadeh, K, Miller, JE, Kovesdy, C, Mehrotra, R, Lukowsky, LR, Streja, E, Ricks, J, Jing, J, Nissenson, AR, Greenland, S & Norris, KC 2010, 'Impact of race on hyperparathyroidism, mineral disarrays, administered vitamin D mimetic, and survival in hemodialysis patients', Journal of Bone and Mineral Research, vol. 25, no. 12, pp. 2448-2458. https://doi.org/10.1002/jbmr.177
Kalantar-Zadeh, Kamyar ; Miller, Jessica E. ; Kovesdy, Csaba ; Mehrotra, Rajnish ; Lukowsky, Lilia R. ; Streja, Elani ; Ricks, Joni ; Jing, Jennie ; Nissenson, Allen R. ; Greenland, Sander ; Norris, Keith C. / Impact of race on hyperparathyroidism, mineral disarrays, administered vitamin D mimetic, and survival in hemodialysis patients. In: Journal of Bone and Mineral Research. 2010 ; Vol. 25, No. 12. pp. 2448-2458.
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AU - Lukowsky, Lilia R.

AU - Streja, Elani

AU - Ricks, Joni

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AU - Nissenson, Allen R.

AU - Greenland, Sander

AU - Norris, Keith C.

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