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Racial-ethnic differences in chronic kidney disease-mineral bone disorder in youth on dialysis

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Abstract

Background

Studies in healthy pediatric populations and adults treated with dialysis demonstrate higher parathyroid hormone (PTH) and lower 25-hydroxyvitamin D levels in African-Americans. Despite these findings, African-Americans on dialysis demonstrate greater bone strength and a decreased risk of fracture compared to the Caucasian dialysis population. The presence of such differences in children and young adult dialysis patients is unknown.

Methods

Differences in the markers of mineral and bone metabolism (MBM) were assessed in 661 incident dialysis patients (aged 1 month to < 21 years). Racial-ethnic differences in PTH, calcium, phosphate, and total alkaline phosphatase (AP) activity were analyzed over the first year of dialysis using multivariate linear mixed models.

Results

African-American race predicted 23% higher serum PTH (95% CI, 4.7–41.3%) when compared to Caucasian patients, while Hispanic ethnicity predicted 17.5% higher PTH (95% CI, 2.3–38%). Upon gender stratification, the differences in PTH were magnified in African-American and Hispanic females: 38% (95% CI, 14.8–69.8%) and 28.8% (95% CI, 4.7–54.9%) higher PTH compared to Caucasian females. Despite higher PTH values, African-American females persistently demonstrated up to 10.9% lower serum AP activity (95% CI, − 20.6–− 0.7%).

Conclusions

There are racial-ethnic differences in the markers of MBM. Higher PTH is seen in African-American and Hispanic children and young adults on dialysis with a magnification of this difference amongst the female population. There is a need to consider how factors like race, ethnicity, and gender impact the goal-targeted treatment of MBM disorders.

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Acknowledgements

We thank DaVita Clinical Research (DCR) for providing statistically de-identified data used in this study.

Funding

The work in this manuscript has been performed with the support of the National Institute of Diabetes, Digestive and Kidney Disease of the National Institute of Health research grants R01-DK95668 (KKZ), K24-DK091419 (KKZ), R01-DK078106 (KKZ), and T32-DK104687 (ML). KKZ is supported by philanthropic grants from Mr. Harold Simmons, Mr. Louis Chang, Mr. Joseph Lee, and AVEO. KN is supported by NIH grants UL1TR000124 and P30AG021684.

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte, Box 951752, Los Angeles, CA, 90095-1752, USA

    Marciana Laster, Robert Elashoff, Keith C. Norris & Isidro B. Salusky

  2. Division of Pediatric Nephrology, Mattel Children’s Hospital at UCLA, Los Angeles, CA, USA

    Marciana Laster & Isidro B. Salusky

  3. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA

    Melissa Soohoo, Elani Streja & Kamyar Kalantar-Zadeh

  4. Division of Pediatric Nephrology, Emory University School of Medicine, Atlanta, GA, USA

    Stephanie Jernigan

  5. Feinberg School of Medicine, Northwestern University and the Anne and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Craig B. Langman

  6. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Kamyar Kalantar-Zadeh

  7. Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA

    Kamyar Kalantar-Zadeh

Authors
  1. Marciana Laster
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  2. Melissa Soohoo
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  3. Elani Streja
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  6. Craig B. Langman
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  7. Keith C. Norris
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  8. Isidro B. Salusky
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  9. Kamyar Kalantar-Zadeh
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Corresponding author

Correspondence to Isidro B. Salusky.

Ethics declarations

Institutional Review Board approval was obtained from the University of California, Irvine. Given the lack of patient identifiable information and the lack of patient burden, consent was exempted in this study.

Conflict of interest

KKZ has received honoraria and/or support from Abbott, Abbvie, Alexion, Amgen, American Society of Nephrology, Astra-Zeneca, AVEO, Chugai, DaVita, Fresenius, Genetech, Haymarket Media, Hospira, Kabi, Keryx, National Institutes of Health, National Kidney Foundation, Relypsa, Resverlogix, Sanofi, Shire, Vifor, and ZS-Pharma. Dr. Isidro B. Salusky is a consultant for Keryx and has received honoraria from Amgen, Abbvie, and OPKO. Dr. Craig B Langman is a consultant for Alexion Pharma Inc., Dicerna Pharma Inc., and Janssen Pharma Inc.

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Laster, M., Soohoo, M., Streja, E. et al. Racial-ethnic differences in chronic kidney disease-mineral bone disorder in youth on dialysis. Pediatr Nephrol 34, 107–115 (2019). https://doi.org/10.1007/s00467-018-4048-6

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  • DOI: https://doi.org/10.1007/s00467-018-4048-6

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