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

Michal L. Melamed, Brad Astor, Erin D. Michos, Thomas H. Hostetter, Neil R. Powe, Paul Muntner

Research output: Contribution to journalArticle

126 Citations (Scopus)

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 ≥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.

Original languageEnglish (US)
Pages (from-to)2631-2639
Number of pages9
JournalJournal of the American Society of Nephrology
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2009

Fingerprint

Kidney Diseases
Chronic Kidney Failure
Incidence
Confidence Intervals
Albuminuria
25-hydroxyvitamin D
Nutrition Surveys
Medicare
Vitamin D
Demography
Hypertension

ASJC Scopus subject areas

  • Nephrology

Cite this

25-Hydroxyvitamin D levels, race, and the progression of kidney disease. / Melamed, Michal L.; Astor, Brad; Michos, Erin D.; Hostetter, Thomas H.; Powe, Neil R.; Muntner, Paul.

In: Journal of the American Society of Nephrology, Vol. 20, No. 12, 01.12.2009, p. 2631-2639.

Research output: Contribution to journalArticle

Melamed, Michal L. ; Astor, Brad ; Michos, Erin D. ; Hostetter, Thomas H. ; Powe, Neil R. ; Muntner, Paul. / 25-Hydroxyvitamin D levels, race, and the progression of kidney disease. In: Journal of the American Society of Nephrology. 2009 ; Vol. 20, No. 12. pp. 2631-2639.
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