title: Bone mineral metabolism parameters and urinary albumin excretion in a representative US population sample.
abstract: OBJECTIVE
  Even within accepted normal ranges, higher serum phosphorus, dietary phosphorus density, parathyroid hormone (PTH) and alkaline phosphatase (ALP) are independent predictors of cardiovascular mortality. Lower serum 25-hydroxy vitamin D (25(OH)D) also predicts adverse cardiovascular outcomes. We hypothesized that vascular dysfunction accompanying subtle disturbances of these bone metabolism parameters would result in associations with increased low grade albuminuria.
  We examined participants in the National Health and Nutrition Examination Surveys 1999-2010 (N = 19,383) with estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m² and without severe albuminuria (urine albumin:creatinine ratio (ACR) <300 mg/g). Albuminuria was quantified as ACR and fractional albumin excretion (FE(alb)).
  
  
  RESULTS
  Increasing quintiles of dietary phosphorus density, serum phosphorus and ALP were not associated with higher ACR or FE(alb). The lowest versus highest quintile of 25(OH)D was associated with greater albuminuria, but not after adjustment for other covariates including cardiovascular risk factors. An association between the highest versus lowest quintile of bone-specific ALP and greater ACR persisted after covariate adjustment, but was not accompanied by an independent association with FE(alb). Increasing quintiles of PTH demonstrated associations with both higher ACR and FE(alb) that were not abolished by adjusting for covariates including age, gender, race, body mass index, diabetes, blood pressure, history of cardiovascular disease, smoking, eGFR, 25(OH)D, season of measurement, lipids, hemoglobin and C-reactive protein. Adjusted increases in ACR and FE(alb) associated with the highest versus lowest quintile of PTH were 19% (95% confidence interval 7-28% p<0.001) and 17% (8-31% p = 0.001) respectively.
  
  
  CONCLUSIONS
  In this population, of the bone mineral parameters associated with cardiovascular outcomes, only PTH is independently associated with ACR and FE(alb).
authors: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom ; Sheffield Kidney Institute, Sheffield, United Kingdom.
authors: Timothy
authors: T
authors: Ellam
authors: Sheffield Kidney Institute, Sheffield, United Kingdom ; School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors: James
authors: J
authors: Fotheringham
authors: Sheffield Kidney Institute, Sheffield, United Kingdom.
authors: Martin E
authors: ME
authors: Wilkie
authors: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
authors: Sheila E
authors: SE
authors: Francis
authors: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
authors: Timothy J A
authors: TJ
authors: Chico
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000097:blood / Q000378:metabolism / Q000652:urine*; D000469:Alkaline Phosphatase / Q000097:blood; D001842:Bone and Bones / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology*; D004032:Diet; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism*; D009749:Nutrition Surveys; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood / Q000378:metabolism; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D008903:Minerals; D010281:Parathyroid Hormone; D014807:Vitamin D; D010758:Phosphorus; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase