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25-Hydroxyvitamin D Levels, Race, and the Progression of Kidney Disease

Michal L. Melamed^*,, Brad Astor, Erin D. Michos, Thomas H. Hostetter^*, Neil R. Powe^|| and Paul Muntner^¶

^* Department of Medicine, Division of Nephrology, and
Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York;
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
^|| Department of Medicine, University of California San Francisco, San Francisco, California;
^¶ Department of Epidemiology and Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama

Correspondence: Dr. Michal L. Melamed, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY 10461. Phone: 718-430-2304; Fax: 718-430-8963; E-mail: mmelamed{at}aecom.yu.edu

Received for publication March 13, 2009. Accepted for publication September 13, 2009.

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 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.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673