Association of serum intact parathyroid hormone with lower estimated glomerular filtration rate

Paul Muntner, Tiffany M. Jones, Amanda D. Hyre, Michal L. Melamed, Arnold Alper, Paolo Raggi, Mary B. Leonard

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background and objectives: The prevalence of mineral metabolism abnormalities is almost universal in stage 5 chronic kidney disease (CKD), but the presence of abnormalities in milder CKD is not well characterized. Design, setting, participants, & measurements: Data on adults ≥20 yr of age from the National Health and Nutrition Examination Survey 2003-2004 (N = 3949) were analyzed to determine the association between moderate declines in estimated GFR (eGFR), calculated using the Modfication of Diet in Renal Disease formula, and serum intact parathyroid hormone (iPTH) ≥ 70 pg/ml. Results: The geometric mean iPTH level was 39.3 pg/ml. The age-standardized prevalence of elevated iPTH was 8.2%, 19.3%, and 38.3% for participants with eGFR ≥ 60, 45 to 59, and 30 to 44 ml/min/1.73 m2, respectively (P-trend < 0.001). After adjustment for age; race/ethnicity; sex; menopausal status; education; income; cigarette smoking; alcohol consumption; body mass index; hypertension; diabetes mellitus; vitamin D supplement use; total calorie and calcium intake; and serum calcium, phosphorus, and 25-hydroxyvitamin D levels - and compared with their counterparts with an eGFR ≥ 60 ml/min/1.73 m2 - the prevalence ratios of elevated iPTH were 2.30 and 4.69 for participants with an eGFR of 45 to 59 and 30 to 44 ml/min/1.73 m2, respectively (P-trend < 0.001). Serum phosphorus ≥ 4.2 mg/dl and 25-hydroxyvitamin D < 17.6 ng/ml were more common at lower eGFR levels. No association was present between lower eGFR and serum calcium < 9.4 mg/dl. Conclusions: This study indicates that elevated iPTH levels are common among patients with moderate CKD.

Original languageEnglish (US)
Pages (from-to)186-194
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume4
Issue number1
DOIs
StatePublished - Jan 1 2009

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Parathyroid Hormone
Glomerular Filtration Rate
Chronic Renal Insufficiency
Serum
Calcium
Phosphorus
Nutrition Surveys
Vitamin D
Alcohol Drinking
Minerals
Diabetes Mellitus
Body Mass Index
Smoking
Diet
Hypertension
Kidney
Education
25-hydroxyvitamin D

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Association of serum intact parathyroid hormone with lower estimated glomerular filtration rate. / Muntner, Paul; Jones, Tiffany M.; Hyre, Amanda D.; Melamed, Michal L.; Alper, Arnold; Raggi, Paolo; Leonard, Mary B.

In: Clinical Journal of the American Society of Nephrology, Vol. 4, No. 1, 01.01.2009, p. 186-194.

Research output: Contribution to journalArticle

Muntner, Paul ; Jones, Tiffany M. ; Hyre, Amanda D. ; Melamed, Michal L. ; Alper, Arnold ; Raggi, Paolo ; Leonard, Mary B. / Association of serum intact parathyroid hormone with lower estimated glomerular filtration rate. In: Clinical Journal of the American Society of Nephrology. 2009 ; Vol. 4, No. 1. pp. 186-194.
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AU - Jones, Tiffany M.

AU - Hyre, Amanda D.

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AU - Raggi, Paolo

AU - Leonard, Mary B.

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AB - Background and objectives: The prevalence of mineral metabolism abnormalities is almost universal in stage 5 chronic kidney disease (CKD), but the presence of abnormalities in milder CKD is not well characterized. Design, setting, participants, & measurements: Data on adults ≥20 yr of age from the National Health and Nutrition Examination Survey 2003-2004 (N = 3949) were analyzed to determine the association between moderate declines in estimated GFR (eGFR), calculated using the Modfication of Diet in Renal Disease formula, and serum intact parathyroid hormone (iPTH) ≥ 70 pg/ml. Results: The geometric mean iPTH level was 39.3 pg/ml. The age-standardized prevalence of elevated iPTH was 8.2%, 19.3%, and 38.3% for participants with eGFR ≥ 60, 45 to 59, and 30 to 44 ml/min/1.73 m2, respectively (P-trend < 0.001). After adjustment for age; race/ethnicity; sex; menopausal status; education; income; cigarette smoking; alcohol consumption; body mass index; hypertension; diabetes mellitus; vitamin D supplement use; total calorie and calcium intake; and serum calcium, phosphorus, and 25-hydroxyvitamin D levels - and compared with their counterparts with an eGFR ≥ 60 ml/min/1.73 m2 - the prevalence ratios of elevated iPTH were 2.30 and 4.69 for participants with an eGFR of 45 to 59 and 30 to 44 ml/min/1.73 m2, respectively (P-trend < 0.001). Serum phosphorus ≥ 4.2 mg/dl and 25-hydroxyvitamin D < 17.6 ng/ml were more common at lower eGFR levels. No association was present between lower eGFR and serum calcium < 9.4 mg/dl. Conclusions: This study indicates that elevated iPTH levels are common among patients with moderate CKD.

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