J Am Soc Nephrol. 2009 Dec;20(12):2631-9. Epub 2009 Oct 29.
Melamed ML, Astor B, Michos ED, Hostetter TH, Powe NR, Muntner P.
Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA. firstname.lastname@example.org
Black individuals have lower 25-hydroxyvitamin D 25(OH)D levels and experience a disproportionate burden of ESRD compared with white individuals. Animal studies suggest that vitamin D has renoprotective effects. We evaluated the contribution of low 25(OH)D levels on incidence of ESRD using data from the Third National Health and Nutrition Examination Survey-linked Medicare claims files (n = 13,328). We included baseline (1988 through 1994) measurements of 25(OH)D and assessed the incidence of ESRD through July 31, 2001.
Overall, 34% of non-Hispanic black individuals had 25(OH)D levels <15 ng/ml compared with 5% of non-Hispanic white individuals (P < 0.001).
During a median of 9.1 yr, 65 participants developed ESRD.
After adjustment for demographic, socioeconomic, and clinical and laboratory factors (including diabetes, hypertension, estimated GFR, and albuminuria), participants with 25(OH)D levels <15 ng/ml had a 2.6-fold greater incidence of ESRD than those with levels > or =15 ng/ml (incidence rate ratio 2.64; 95% confidence interval CI 1.00 to 7.05; P = 0.05).
After adjustment for clinical covariates but not 25(OH)D levels, non-Hispanic black individuals had a 2.83-fold (95% CI 1.03 to 7.77) higher risk for developing ESRD compared with non-Hispanic white individuals.
Additional adjustment for 25(OH)D levels reduced the risk by 58% (incidence rate ratio 1.77; 95% CI 0.38 to 8.21).
In summary, low 25(OH)D levels associate with development of ESRD even after adjustment for multiple risk factors.
Low 25(OH)D levels may account for a substantial proportion of the increased risk for ESRD experienced by black individuals.