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Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease.

dc.contributor.author Scialla, Julia
dc.contributor.author Wolf, Myles
dc.contributor.author Wahl, Patricia
dc.contributor.author Xie, Huiliang
dc.contributor.author Anderson, Cheryl AM
dc.contributor.author Bellovich, Keith
dc.contributor.author Brecklin, Carolyn
dc.contributor.author Chen, Jing
dc.contributor.author Feldman, Harold
dc.contributor.author Gutierrez, Orlando M
dc.contributor.author Lash, Jim
dc.contributor.author Leonard, Mary B
dc.contributor.author Negrea, Lavinia
dc.contributor.author Rosas, Sylvia E
dc.contributor.author Anderson, Amanda Hyre
dc.contributor.author Townsend, Raymond R
dc.contributor.author Isakova, Tamara
dc.date.accessioned 2019-05-01T15:54:04Z
dc.date.available 2019-05-01T15:54:04Z
dc.date.issued 2012-05
dc.identifier dc11-2235
dc.identifier.issn 0149-5992
dc.identifier.issn 1935-5548
dc.identifier.uri https://hdl.handle.net/10161/18487
dc.description.abstract Disordered mineral metabolism is a common complication of chronic kidney disease (CKD) and a novel risk factor for CKD progression, cardiovascular disease, and mortality. Although diabetes is the leading cause of CKD and is associated with worse clinical outcomes than other etiologies, few studies have evaluated mineral metabolism in CKD according to diabetes status.Using the Chronic Renal Insufficiency Cohort Study, we tested the hypothesis that diabetes is independently associated with lower serum calcium and higher serum phosphate, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF23).Compared with participants without diabetes (n = 1,936), those with diabetes (n = 1,820) were more likely to have lower estimated glomerular filtration rate (eGFR), lower serum albumin, and higher urinary protein excretion (all P < 0.001). Unadjusted serum phosphate, PTH, and FGF23 levels were higher and calcium was lower among those with compared with those without diabetes (all P < 0.001). After multivariate adjustment, diabetes remained a significant predictor of serum phosphate, PTH, and FGF23 but not calcium. The eGFR cut point at which 50% of participants met criteria for secondary hyperparathyroidism or elevated FGF23 was higher in participants with diabetes compared with those without (PTH: eGFR 30-39 vs. 20-29, P < 0.001; FGF23: eGFR 50-59 vs. 40-49, P < 0.001).Disordered mineral metabolism begins earlier in the course of CKD and is more severe among CKD patients with compared with those without diabetes. Future studies should explore mechanisms for these differences and whether they contribute to excess risks of adverse clinical outcomes among diabetic patients with CKD.
dc.language eng
dc.publisher American Diabetes Association
dc.relation.ispartof Diabetes care
dc.relation.isversionof 10.2337/dc11-2235
dc.subject Chronic Renal Insufficiency Cohort Study Group
dc.subject Humans
dc.subject Kidney Diseases
dc.subject Diabetes Mellitus
dc.subject Phosphates
dc.subject Calcium
dc.subject Parathyroid Hormone
dc.subject Fibroblast Growth Factors
dc.subject Glomerular Filtration Rate
dc.subject Adult
dc.subject Aged
dc.subject Middle Aged
dc.subject Female
dc.subject Male
dc.title Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease.
dc.type Journal article
duke.contributor.id Scialla, Julia|0122355
duke.contributor.id Wolf, Myles|0721663
dc.date.updated 2019-05-01T15:54:03Z
pubs.begin-page 994
pubs.end-page 1001
pubs.issue 5
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine, Nephrology
pubs.organisational-group Medicine
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Population Health Sciences
pubs.organisational-group Basic Science Departments
pubs.publication-status Published
pubs.volume 35


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