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

29 Citations (Scopus)

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
Pages (from-to)994-1001
Number of pages8
JournalDiabetes Care
Volume35
Issue number5
DOIs
StatePublished - May 1 2012

Fingerprint

Chronic Renal Insufficiency
Minerals
Parathyroid Hormone
Glomerular Filtration Rate
Phosphates
Calcium
Serum
Secondary Hyperparathyroidism
Serum Albumin
Disease Progression
Cohort Studies
Research Design
Cardiovascular Diseases
fibroblast growth factor 23
Mortality
Proteins

ASJC Scopus subject areas

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

Cite this

Wahl, P., Xie, H., Scialla, J., Anderson, C. A. M., Bellovich, K., Brecklin, C., ... 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

Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease. / Wahl, Patricia; Xie, Huiliang; Scialla, Julia; Anderson, Cheryl A M; Bellovich, Keith; Brecklin, Carolyn; Chen, Jing; Feldman, Harold; Gutierrez, Orlando M.; Lash, Jim; Leonard, Mary B.; Negrea, Lavinia; Rosas, Sylvia E.; Anderson, Amanda Hyre; Townsend, Raymond R.; Wolf, Myles; Isakova, Tamara.

In: Diabetes Care, Vol. 35, No. 5, 01.05.2012, p. 994-1001.

Research output: Contribution to journalArticle

Wahl, P, Xie, H, Scialla, J, Anderson, CAM, Bellovich, K, Brecklin, C, Chen, J, Feldman, H, Gutierrez, OM, Lash, J, Leonard, MB, Negrea, L, Rosas, SE, Anderson, AH, Townsend, RR, Wolf, M & Isakova, T 2012, 'Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease', Diabetes Care, vol. 35, no. 5, pp. 994-1001. https://doi.org/10.2337/dc11-2235
Wahl, Patricia ; Xie, Huiliang ; Scialla, Julia ; Anderson, Cheryl A M ; Bellovich, Keith ; Brecklin, Carolyn ; Chen, Jing ; Feldman, Harold ; Gutierrez, Orlando M. ; Lash, Jim ; Leonard, Mary B. ; Negrea, Lavinia ; Rosas, Sylvia E. ; Anderson, Amanda Hyre ; Townsend, Raymond R. ; Wolf, Myles ; Isakova, Tamara. / Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease. In: Diabetes Care. 2012 ; Vol. 35, No. 5. pp. 994-1001.
@article{106056f2ac34485d8454303be2e81843,
title = "Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease",
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.",
author = "Patricia Wahl and Huiliang Xie and Julia Scialla and Anderson, {Cheryl A M} and Keith Bellovich and Carolyn Brecklin and Jing Chen and Harold Feldman and Gutierrez, {Orlando M.} and Jim Lash and Leonard, {Mary B.} and Lavinia Negrea and Rosas, {Sylvia E.} and Anderson, {Amanda Hyre} and Townsend, {Raymond R.} and Myles Wolf and Tamara Isakova",
year = "2012",
month = "5",
day = "1",
doi = "10.2337/dc11-2235",
language = "English",
volume = "35",
pages = "994--1001",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "5",

}

TY - JOUR

T1 - Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease

AU - Wahl, Patricia

AU - Xie, Huiliang

AU - Scialla, Julia

AU - Anderson, Cheryl A M

AU - Bellovich, Keith

AU - Brecklin, Carolyn

AU - Chen, Jing

AU - Feldman, Harold

AU - Gutierrez, Orlando M.

AU - Lash, Jim

AU - Leonard, Mary B.

AU - Negrea, Lavinia

AU - Rosas, Sylvia E.

AU - Anderson, Amanda Hyre

AU - Townsend, Raymond R.

AU - Wolf, Myles

AU - Isakova, Tamara

PY - 2012/5/1

Y1 - 2012/5/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84862095188&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862095188&partnerID=8YFLogxK

U2 - 10.2337/dc11-2235

DO - 10.2337/dc11-2235

M3 - Article

C2 - 22446176

AN - SCOPUS:84862095188

VL - 35

SP - 994

EP - 1001

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 5

ER -