Modifiers of Plasma 25-Hydroxyvitamin D and Chronic Kidney Disease Outcomes in Black Americans: The Jackson Heart Study

Abstract Background 25-hydroxyvitamin D [25(OH)D] is lower in black compared with white Americans but is not consistently associated with outcomes in this group, possibly due to genetic and other biological differences. We examined the association of plasma 25(OH)D and renal outcomes in black Americ...

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Published in:The journal of clinical endocrinology and metabolism 2019-06, Vol.104 (6), p.2267-2276
Main Authors: Lunyera, Joseph, Davenport, Clemontina A, Pendergast, Jane, Musani, Solomon K, Bhavsar, Nrupen A, Sims, Mario, Mwasongwe, Stanford, Wolf, Myles, Diamantidis, Clarissa J, Boulware, L Ebony, Scialla, Julia J
Format: Article
Language:English
Subjects:
25-Hydroxyvitamin D
Adult
African Americans
Aged
Aged, 80 and over
Aldosterone
Alfacalcidol
Angiotensin
Black or African American
Calcifediol
Chronic kidney failure
Clinical s
Diabetes
Diabetes mellitus
Diabetics
Dietary intake
Epidermal growth factor receptors
Female
Generalized linear models
Genotype
Genotypes
Glomerular Filtration Rate
Humans
Kidney diseases
Longitudinal Studies
Male
Middle Aged
Plasma
Prospective Studies
Protein binding
Renal Insufficiency, Chronic - blood
Renal Insufficiency, Chronic - physiopathology
Renin
Sodium
Vitamin D
Vitamin D - analogs & derivatives
Vitamin D - blood
Vitamin D-Binding Protein - genetics
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Summary:Abstract Background 25-hydroxyvitamin D [25(OH)D] is lower in black compared with white Americans but is not consistently associated with outcomes in this group, possibly due to genetic and other biological differences. We examined the association of plasma 25(OH)D and renal outcomes in black Americans with a focus on effect modifiers. Methods We studied associations between baseline 25(OH)D with (i) annual rate of estimated glomerular filtration rate (eGFR) decline and (ii) incident chronic kidney disease (CKD) in the Jackson Heart Study, a prospective cohort of black Americans. Plasma 25(OH)D levels were corrected for monthly variation in sunlight exposure using the residual method. We used adjusted generalized linear models to evaluate outcomes and assessed potential effect modification by diabetes mellitus, vitamin D binding protein (DBP) genotype, obesity, dietary sodium intake, and use of renin-angiotensin-aldosterone system inhibitors. Results Among 5164 participants with 25(OH)D available, plasma 25(OH)D was 14.5 ± 6.5 ng/mL (mean ± SD), and eGFR was 94.1 ± 22.0 mL/min/1.73 m2. Over a median of 8 years, eGFR decline was 1.3 ± 2.0 mL/min/1.73 m2 per year in 3228 participants with complete data, and 220 out of 1803 eligible participants developed incident CKD. Overall, 25(OH)D was not associated with eGFR decline in fully adjusted models. However, higher 25(OH)D was associated with slower eGFR decline among those with diabetes: each 5 ng/mL higher 25(OH)D was associated with a 0.27 mL/min/1.73 m2/y slower eGFR decline (95% CI, 0.13 to 0.41; P < 0.001). Higher 25(OH)D was not associated with incident CKD overall, but it was associated with lower odds of incident CKD among participants with the GG or GT genotype at rs7041 in the gene encoding DBP [OR, 0.69 per 5 ng/mL higher 25(OH)D; 95% CI, 0.51 to 0.93; P-interaction = 0.005]. Other interactions were not significant. Conclusion These findings support a potential benefit of higher 25(OH)D for kidney health in black Americans with diabetes or specific variants in DBP. We elucidate a potential benefit of higher plasma 25-hydroxyvitamin D for CKD in a subset of blacks with diabetes and genetic variants that confer lower levels of the biologically active hormone.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2018-01747