Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease

Patricia Wahl, Huiliang Xie, Julia Scialla, Cheryl A.M. Anderson, Keith Bellovich, Carolyn Brecklin, Jing Chen, Harold Feldman, Orlando M. Gutierrez, Jim Lash, Mary B. Leonard, Lavinia Negrea, Sylvia E. Rosas, Amanda Hyre Anderson, Raymond R. Townsend, Myles Wolf, Tamara Isakova

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

OBJECTIVE - Disordered mineral metabolism is a common complication of chronic kidney disease (CKD) and a novel risk factor for CKD progression, cardiovascular disease, and mortality. Although diabetes is the leading cause of CKD and is associated with worse clinical outcomes than other etiologies, few studies have evaluated mineral metabolism in CKD according to diabetes status. RESEARCH DESIGN AND METHODS - Using the Chronic Renal Insufficiency Cohort Study, we tested the hypothesis that diabetes is independently associated with lower serum calcium and higher serum phosphate, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF23). RESULTS - Compared with participants without diabetes (n = 1,936), thosewith diabetes (n = 1,820) were more likely to have lower estimated glomerular filtration rate (eGFR), lower serum albumin, and higher urinary protein excretion (all P<0.001). Unadjusted serum phosphate, PTH, and FGF23 levels were higher and calcium was lower among those with compared with those without diabetes (all P < 0.001). After multivariate adjustment, diabetes remained a significant predictor of serum phosphate, PTH, and FGF23 but not calcium. The eGFR cut point at which 50% of participants met criteria for secondary hyperparathyroidism or elevated FGF23 was higher in participants with diabetes compared with those without (PTH: eGFR 30-39 vs. 20-29, P < 0.001; FGF23: eGFR 50-59 vs. 40-49, P < 0.001). CONCLUSIONS - Disordered mineral metabolism begins earlier in the course of CKD and is more severe among CKD patients with compared with those without diabetes. Future studies should explore mechanisms for these differences and whether they contribute to excess risks of adverse clinical outcomes among diabetic patients with CKD.

Original languageEnglish (US)
Pages (from-to)994-1001
Number of pages8
JournalDiabetes care
Volume35
Issue number5
DOIs
StatePublished - May 2012

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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    Wahl, P., Xie, H., Scialla, J., Anderson, C. A. M., Bellovich, K., Brecklin, C., Chen, J., Feldman, H., Gutierrez, O. M., Lash, J., Leonard, M. B., Negrea, L., Rosas, S. E., Anderson, A. H., Townsend, R. R., Wolf, M., & Isakova, T. (2012). Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease. Diabetes care, 35(5), 994-1001. https://doi.org/10.2337/dc11-2235