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Association of Serum Intact Parathyroid Hormone with Lower Estimated Glomerular Filtration Rate

Paul Muntner^*, Tiffany M. Jones, Amanda D. Hyre, Michal L. Melamed, Arnold Alper, Paolo Raggi^¶, and Mary B. Leonard^,||

^* Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York; ^¶ Department of Medicine, Emory University, Atlanta, Georgia; and ^|| Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Correspondence: Dr. Paul Muntner, Department of Community and Preventive Medicine, Mount Sinai School of Medicine, 1 Gustave L Levy Place, Box 1057, New York, NY 10016; Phone: (212) 824-7024; Fax: (212) 996-0407; E-mail: paul.muntner{at}mssm.edu

Background and objectives: The prevalence of mineral metabolism abnormalities is almost universal in stage 5 chronic kidney disease (CKD), but the presence of abnormalities in milder CKD is not well characterized.

Design, setting, participants, & measurements: Data on adults 20 yr of age from the National Health and Nutrition Examination Survey 2003–2004 (N = 3949) were analyzed to determine the association between moderate declines in estimated GFR (eGFR), calculated using the Modfication of Diet in Renal Disease formula, and serum intact parathyroid hormone (iPTH) 70 pg/ml.

Results: The geometric mean iPTH level was 39.3 pg/ml. The age-standardized prevalence of elevated iPTH was 8.2%, 19.3%, and 38.3% for participants with eGFR 60, 45 to 59, and 30 to 44 ml/min/1.73 m², respectively (P-trend < 0.001). After adjustment for age; race/ethnicity; sex; menopausal status; education; income; cigarette smoking; alcohol consumption; body mass index; hypertension; diabetes mellitus; vitamin D supplement use; total calorie and calcium intake; and serum calcium, phosphorus, and 25-hydroxyvitamin D levels—and compared with their counterparts with an eGFR 60 ml/min/1.73 m²—the prevalence ratios of elevated iPTH were 2.30 and 4.69 for participants with an eGFR of 45 to 59 and 30 to 44 ml/min/1.73 m², respectively (P-trend < 0.001). Serum phosphorus 4.2 mg/dl and 25-hydroxyvitamin D < 17.6 ng/ml were more common at lower eGFR levels. No association was present between lower eGFR and serum calcium < 9.4 mg/dl.

Conclusions: This study indicates that elevated iPTH levels are common among patients with moderate CKD.