25-hydroxyvitamin D levels, race, and the progression of kidney disease.

Abstract

Black individuals have lower 25-hydroxyvitamin D [25(OH)D] levels and experience a disproportionate burden of ESRD compared with white individuals. Animal studies suggest that vitamin D has renoprotective effects. We evaluated the contribution of low 25(OH)D levels on incidence of ESRD using data from the Third National Health and Nutrition Examination Survey-linked Medicare claims files (n = 13,328). We included baseline (1988 through 1994) measurements of 25(OH)D and assessed the incidence of ESRD through July 31, 2001. Overall, 34% of non-Hispanic black individuals had 25(OH)D levels <15 ng/ml compared with 5% of non-Hispanic white individuals (P < 0.001). During a median of 9.1 yr, 65 participants developed ESRD. After adjustment for demographic, socioeconomic, and clinical and laboratory factors (including diabetes, hypertension, estimated GFR, and albuminuria), participants with 25(OH)D levels <15 ng/ml had a 2.6-fold greater incidence of ESRD than those with levels > or =15 ng/ml (incidence rate ratio 2.64; 95% confidence interval [CI] 1.00 to 7.05; P = 0.05). After adjustment for clinical covariates but not 25(OH)D levels, non-Hispanic black individuals had a 2.83-fold (95% CI 1.03 to 7.77) higher risk for developing ESRD compared with non-Hispanic white individuals. Additional adjustment for 25(OH)D levels reduced the risk by 58% (incidence rate ratio 1.77; 95% CI 0.38 to 8.21). In summary, low 25(OH)D levels associate with development of ESRD even after adjustment for multiple risk factors. Low 25(OH)D levels may account for a substantial proportion of the increased risk for ESRD experienced by black individuals.

• Authors: Michal L Melamed, Brad Astor, Erin D Michos, Thomas H Hostetter, Neil R Powe, Paul Muntner
• Journal: Journal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 20 Issue 12 Pg. 2631-9 (Dec 2009) ISSN: 1533-3450 [Electronic] United States
• PMID: 19875805 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Vitamin D
• 25-hydroxyvitamin D

Topics

• Adult
• Black or African American
• Aged
• Data Collection
• Female
• Humans
• Kidney Failure, Chronic (blood, epidemiology, etiology)
• Male
• Mexican Americans
• Middle Aged
• Risk Factors
• Time Factors
• United States (epidemiology)
• Vitamin D (analogs & derivatives, blood)
• Vitamin D Deficiency (blood, complications, epidemiology)
• White People