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

Wahl, Patricia

Xie, Huiliang

Scialla, Julia

Anderson, Cheryl AM

Bellovich, Keith

Brecklin, Carolyn

Chen, Jing

Feldman, Harold

Gutierrez, Orlando M

Lash, Jim

Leonard, Mary B

Negrea, Lavinia

Rosas, Sylvia E

Anderson, Amanda Hyre

Townsend, Raymond R

Wolf, Myles

Isakova, Tamara

Chronic Renal Insufficiency Cohort Study Group

2019-05-01T15:54:04Z

2019-05-01T15:54:04Z

2012-05

2019-05-01T15:54:03Z

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.

dc11-2235

0149-5992

1935-5548

https://hdl.handle.net/10161/18487

eng

American Diabetes Association

Diabetes care

10.2337/dc11-2235

Chronic Renal Insufficiency Cohort Study Group

Humans

Kidney Diseases

Diabetes Mellitus

Phosphates

Calcium

Parathyroid Hormone

Fibroblast Growth Factors

Glomerular Filtration Rate

Adult

Aged

Middle Aged

Female

Male

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

Journal article

Wolf, Myles|0000-0002-1127-1442

994

1001

5

School of Medicine

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine, Nephrology

Medicine

Clinical Science Departments

Population Health Sciences

Basic Science Departments

Published

35