Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, USA.
Clin J Am Soc Nephrol. 2012 Apr;7(4):640-7. doi: 10.2215/CJN.07020711. Epub 2012 Mar 1.
This study examined differences in the concentration of markers of mineral metabolism across race in patients with advanced CKD not requiring dialysis and ESRD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Concentrations of 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), intact parathyroid hormone (iPTH), and fibroblast growth factor 23 (FGF-23) were measured in stored plasma samples of 1497 patients with advanced CKD not yet on dialysis and ESRD who participated in the Homocysteine in Kidney and End Stage Renal Disease study. Linear regression models were used to examine the relationship between race and 25(OH)D, 1,25(OH)(2)D, iPTH, and FGF-23 concentrations.
Non-Hispanic white patients comprised 58% of the cohort, whereas non-Hispanic blacks comprised 42%. Median (interquartile range) FGF-23 concentrations were lower in blacks compared with whites with CKD (323 [181-655] versus 431 [232-1026] RU/ml; P<0.001) but not in ESRD. In adjusted linear regression models, blacks with CKD not requiring dialysis had significantly lower plasma FGF-23 concentrations (difference, -159; 95% confidence interval, -205 to -106; P<0.001) compared with whites, independent of plasma 25(OH)D, 1,25(OH)(2)D, and iPTH concentrations. This difference was not observed in the ESRD group. The magnitude of correlation for the relationships between 1,25(OH)(2)D with iPTH, FGF-23 with 1,25(OH)(2)D, and FGF-23 with iPTH were stronger among blacks than whites with CKD not requiring dialysis.
In advanced CKD not requiring dialysis, blacks have lower FGF-23 concentrations than whites. Blacks with CKD and ESRD have lower 25(OH)D and higher iPTH compared with whites, independent of FGF-23 concentrations.
本研究旨在比较不同种族的晚期慢性肾脏病（CKD）未透析和终末期肾病（ESRD）患者的矿物质代谢标志物浓度差异。
设计、地点、参与者和测量：在参加同型半胱氨酸在肾脏和终末期肾病研究的 1497 例晚期 CKD 未透析和 ESRD 患者的储存血浆样本中，测量了 25-羟维生素 D（25（OH）D）、1,25-二羟维生素 D（1,25（OH）（2）D）、完整甲状旁腺激素（iPTH）和成纤维细胞生长因子 23（FGF-23）的浓度。线性回归模型用于研究种族与 25（OH）D、1,25（OH）（2）D、iPTH 和 FGF-23 浓度之间的关系。
非西班牙裔白人患者占队列的 58%，而非西班牙裔黑人患者占 42%。与 CKD 白人患者相比，黑人患者的 FGF-23 浓度中位数（四分位距）较低（323 [181-655] 与 431 [232-1026] RU/ml；P<0.001），但在 ESRD 患者中则不然。在调整后的线性回归模型中，与白人患者相比，不需要透析的 CKD 黑人患者的血浆 FGF-23 浓度显著降低（差异，-159；95%置信区间，-205 至-106；P<0.001），而与血浆 25（OH）D、1,25（OH）（2）D 和 iPTH 浓度无关。在 ESRD 组中未观察到这种差异。在不需要透析的 CKD 患者中，1,25（OH）（2）D 与 iPTH、FGF-23 与 1,25（OH）（2）D、FGF-23 与 iPTH 之间的关系，黑人的相关性强度强于白人。
在不需要透析的晚期 CKD 中，黑人的 FGF-23 浓度低于白人。与白人患者相比，CKD 和 ESRD 的黑人患者的 25（OH）D 水平较低，iPTH 水平较高，而 FGF-23 浓度则不受影响。
