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

Journal Article (Journal Article)

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), those with 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.

Full Text

Duke Authors

Cited Authors

  • 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; Chronic Renal Insufficiency Cohort Study Group,

Published Date

  • May 2012

Published In

Volume / Issue

  • 35 / 5

Start / End Page

  • 994 - 1001

PubMed ID

  • 22446176

Pubmed Central ID

  • PMC3329844

Electronic International Standard Serial Number (EISSN)

  • 1935-5548

Digital Object Identifier (DOI)

  • 10.2337/dc11-2235


  • eng

Conference Location

  • United States