title: 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.affiliation: Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA. mmelamed@aecom.yu.edu
authors.forename: Michal L
authors.initials: ML
authors.lastname: Melamed
authors.forename: Brad
authors.initials: B
authors.lastname: Astor
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Hostetter
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D003625:Data Collection; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology; D044465:White People
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D