Impact of race on hyperparathyroidism, mineral disarrays, administered vitamin D mimetic, and survival in hemodialysis patients

Authors

  • Kamyar Kalantar-Zadeh,

    Corresponding author
    1. Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    2. Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    3. UCLA David Geffen School of Medicine, UCLA School of Public Health, Los Angeles, CA, USA
    4. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
    • Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA 90509-2910, USA.
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  • Jessica E Miller,

    1. Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    2. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
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  • Csaba P Kovesdy,

    1. Division of Nephrology, Salem Veterans Administration Medical Center, Salem, VA, USA
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  • Rajnish Mehrotra,

    1. Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    2. UCLA David Geffen School of Medicine, UCLA School of Public Health, Los Angeles, CA, USA
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  • Lilia R Lukowsky,

    1. Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    2. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
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  • Elani Streja,

    1. Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    2. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
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  • Joni Ricks,

    1. Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    2. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
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  • Jennie Jing,

    1. Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    2. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
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  • Allen R Nissenson,

    1. UCLA David Geffen School of Medicine, UCLA School of Public Health, Los Angeles, CA, USA
    2. DaVita Inc. El Segundo, CA, USA
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  • Sander Greenland,

    1. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
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  • Keith C Norris

    1. UCLA David Geffen School of Medicine, UCLA School of Public Health, Los Angeles, CA, USA
    2. Department of Medicine, Charles Drew University, Los Angeles, CA, USA
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Abstract

Blacks have high rates of chronic kidney disease, are overrepresented among the US dialysis patients, have higher parathyroid hormone levels, but greater survival compared to nonblacks. We hypothesized that mineral and bone disorders (MBDs) have a bearing on survival advantages of black hemodialysis patients. In 139,328 thrice-weekly treated hemodialysis patients, including 32% blacks, in a large dialysis organization, where most laboratory values were measured monthly for up to 60 months (July 2001 to June 2006), we examined differences across races in measures of MBDs and survival predictabilities of these markers and administered the active vitamin D medication paricalcitol. Across each age increment, blacks had higher serum calcium and parathyroid hormone (PTH) levels and almost the same serum phosphorus and alkaline phosphatase levels and were more likely to receive injectable active vitamin D in the dialysis clinic, mostly paricalcitol, at higher doses than nonblacks. Racial differences existed in mortality predictabilities of different ranges of serum calcium, phosphorus, and PTH but not alkaline phosphatase. Blacks who received the highest dose of paricalcitol (>10 µg/week) had a demonstrable survival advantage over nonblacks (case-mix-adjusted death hazard ratio = 0.87, 95% confidence level 0.83–0.91) compared with those who received lower doses (<10 µg/week) or no active vitamin D. Hence, in black hemodialysis patients, hyperparathyroidism and hypercalcemia are more prevalent than in nonblacks, whereas hyperphosphatemia or hyperphosphatasemia are not. Survival advantages of blacks appear restricted to those receiving higher doses of active vitamin D. Examining the effect of MBD modulation on racial survival disparities of hemodialysis patients is warranted. © 2010 American Society for Bone and Mineral Research.

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