Gutiérrez O M, Isakova T, Andress D L, Levin A, Wolf M
Department of Medicine, Renal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Kidney Int. 2008 Apr;73(8):956-62. doi: 10.1038/ki.2008.4. Epub 2008 Feb 6.
Disorders of mineral metabolism develop early in chronic kidney disease, but it appears that Blacks with stage-5 disease have more severe secondary hyperparathyroidism than other races. We measured levels of parathyroid hormone, calcium, phosphorus, 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) in 227 Black and 1633 non-Black participants in the SEEK study, a multi-center cohort of patients with early chronic kidney disease. Overall, Blacks had similar 1,25D levels compared with non-Blacks, but significantly lower levels of 25D with higher levels of calcium, phosphorus, and parathyroid hormone, and were significantly more likely to have hyperphosphatemia than non-Blacks. In multivariable analyses adjusted for age, gender, estimated glomerular filtration rate, body mass index, and diabetes, Blacks had significantly lower 25D and higher parathyroid hormone levels than non-Blacks, with the latter parameter remaining significant after further adjustment for calcium, phosphorus, 25D, and 1,25D. The association between Black race and secondary hyperparathyroidism, independent of known risk factors, suggests that novel mechanisms contribute to secondary hyperparathyroidism in Blacks with chronic kidney disease.
矿物质代谢紊乱在慢性肾脏病早期就会出现，但似乎5期疾病的黑人比其他种族有更严重的继发性甲状旁腺功能亢进。我们在SEEK研究的227名黑人参与者和1633名非黑人参与者中测量了甲状旁腺激素、钙、磷、25-羟维生素D（25D）和1,25-二羟维生素D（1,25D）的水平，SEEK研究是一个早期慢性肾脏病患者的多中心队列研究。总体而言，与非黑人相比，黑人的1,25D水平相似，但25D水平显著较低，钙、磷和甲状旁腺激素水平较高，且黑人发生高磷血症的可能性显著高于非黑人。在对年龄、性别、估计肾小球滤过率、体重指数和糖尿病进行校正的多变量分析中，黑人的25D水平显著低于非黑人，甲状旁腺激素水平高于非黑人，在进一步对钙、磷、25D和1,25D进行校正后，后一参数仍具有显著性。黑人种族与继发性甲状旁腺功能亢进之间的关联独立于已知危险因素，这表明新的机制导致了慢性肾脏病黑人患者的继发性甲状旁腺功能亢进。
