The Association between Parathyroid Hormone Levels and Hemoglobin in Diabetic and Nondiabetic Participants in the National Kidney Foundationʼs Kidney Early Evaluation Program

Cardiorenal Medicine

Peter A. McCullough¹  Manjula Kurella Tamura¹  Adam Whaley-Connell¹  Carmen Peralta¹  Imran Memon¹  Shu-Cheng Chen¹  Suying Li¹  Claudine Jurkovitz¹  for the Kidney Early Evaluation Program Investigators¹  Andrew S. Bomback¹  Georges Saab¹  Keith C. Norris¹ 

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关键词: Chronic kidney disease;    Anemia;    Secondary hyperparathyroidism;   

DOI  :  10.1159/000351229

来源: S Karger AG

【 摘 要 】

Background: Both anemia and secondary hyperparathyroidism are reflections of hormonal failure in chronic kidney disease (CKD). While the association of elevated levels of parathyroid hormone (PTH) and anemia has been studied among those with advanced CKD, less is known about this association in mild-to-moderate CKD. Methods: In a cross-sectional analysis, the relationship between PTH and hemoglobin levels was investigated in 10,750 participants in the National Kidney Foundationʼs Kidney Early Evaluation Program with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Results: In the unadjusted analysis, higher PTH levels were associated with lower hemoglobin levels. However, after multivariable adjustment for age, race, gender, smoking status, education, cardiovascular disease, diabetes, hypertension, cancer, albuminuria, BMI, baseline eGFR, calcium, and phosphorus, the direction of association changed. As compared to the first PTH quintile, hemoglobin levels were 0.09 g/dl (95% CI: 0.01-0.18), 0.15 g/dl (95% CI: 0.07-0.24), 0.18 g/dl (95% CI: 0.09-0.26), and 0.13 g/dl (95% CI: 0.07-0.25) higher for the second, third, fourth, and fifth quintiles, respectively. Similarly, each standard deviation increase in natural log transformed PTH was associated with a 0.06 g/dl (95% CI: 0.03-0.09, p = 0.0003) increase in hemoglobin. However, a significant effect modification was seen for diabetes (p = 0.0003). Each standard deviation increase in natural log transformed PTH was associated with a 0.10 g/dl (95% CI: 0.054-0.138, p < 0.0001) increase in hemoglobin, while no association was seen among those without diabetes mellitus. Conclusion: After multivariable adjustment, there was a small positive association between PTH and hemoglobin among diabetics but not among nondiabetics.

【 授权许可】

Unknown