Racial-ethnic differences in chronic kidney disease-mineral bone disorder in youth on dialysis

Marciana Laster, Melissa Soohoo, Elani Streja, Robert Elashoff, Stephanie Jernigan, Craig B. Langman, Keith C. Norris, Isidro B. Salusky*, Kamyar Kalantar-Zadeh

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Studies in healthy pediatric populations and adults treated with dialysis demonstrate higher parathyroid hormone (PTH) and lower 25-hydroxyvitamin D levels in African-Americans. Despite these findings, African-Americans on dialysis demonstrate greater bone strength and a decreased risk of fracture compared to the Caucasian dialysis population. The presence of such differences in children and young adult dialysis patients is unknown. Methods: Differences in the markers of mineral and bone metabolism (MBM) were assessed in 661 incident dialysis patients (aged 1 month to < 21 years). Racial-ethnic differences in PTH, calcium, phosphate, and total alkaline phosphatase (AP) activity were analyzed over the first year of dialysis using multivariate linear mixed models. Results: African-American race predicted 23% higher serum PTH (95% CI, 4.7–41.3%) when compared to Caucasian patients, while Hispanic ethnicity predicted 17.5% higher PTH (95% CI, 2.3–38%). Upon gender stratification, the differences in PTH were magnified in African-American and Hispanic females: 38% (95% CI, 14.8–69.8%) and 28.8% (95% CI, 4.7–54.9%) higher PTH compared to Caucasian females. Despite higher PTH values, African-American females persistently demonstrated up to 10.9% lower serum AP activity (95% CI, − 20.6–− 0.7%). Conclusions: There are racial-ethnic differences in the markers of MBM. Higher PTH is seen in African-American and Hispanic children and young adults on dialysis with a magnification of this difference amongst the female population. There is a need to consider how factors like race, ethnicity, and gender impact the goal-targeted treatment of MBM disorders.

Original languageEnglish (US)
Pages (from-to)107-115
Number of pages9
JournalPediatric Nephrology
Volume34
Issue number1
DOIs
StatePublished - Jan 1 2019

Keywords

  • Biochemical markers of bone turnover
  • Children
  • Chronic kidney disease-mineral bone disease
  • Dialysis
  • Parathyroid-related disorders

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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    Laster, M., Soohoo, M., Streja, E., Elashoff, R., Jernigan, S., Langman, C. B., Norris, K. C., Salusky, I. B., & Kalantar-Zadeh, K. (2019). Racial-ethnic differences in chronic kidney disease-mineral bone disorder in youth on dialysis. Pediatric Nephrology, 34(1), 107-115. https://doi.org/10.1007/s00467-018-4048-6