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Author Notes:

Corresponding Author: Julia Scialla, MD, MHS, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, Email: julia.scialla@duke.edu

We thank the patients, staff and medical directors of the participating clinics and the DCI Central Laboratory who contributed to the study.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ, NHLBI, NIDDK, NIH, or Abbvie Laboratories

Conflict of Interest Statement: R Parekh: Research funding from Abbvie Laboratories

All other authors have nothing to disclose


Research Funding:

CHOICE was supported by grants R01DK59616, R01DK080123 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD; R01HS08365 from the Agency for Health Care Research and Quality (AHRQ), Rockville, MD; and R01HL62985 from the National Heart Lung and Blood Institute (NHLBI), Bethesda, MD.

In addition this work was supported in part by K23DK078774 and U01DK087783 (Melamed), K23DK095949 (Scialla), K23DK083514 (Shafi) each from the NIDDK; KL2RR025006 (Scialla) from the National Center for Research Resources, National Institutes of Health (NIH) Roadmap for Medical Research; a Carl Gottschalk Award from the American Society of Nephrology (Melamed) and a grant from Abbvie Laboratories (Parekh).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Urology & Nephrology
  • Dialysis
  • End-stage renal disease
  • Epidemiology
  • Fibroblast growth factor 23
  • Phosphorus
  • Vitamin D

Race, Mineral Homeostasis and Mortality in Patients with End-Stage Renal Disease on Dialysis


Journal Title:

American Journal of Nephrology


Volume 42, Number 1


, Pages 25-34

Type of Work:

Article | Post-print: After Peer Review


Background: Abnormalities in mineral homeostasis are ubiquitous in patients on dialysis, and influenced by race. In this study, we determine the race-specific relationship between mineral parameters and mortality in patients initiating hemodialysis. Methods: We measured the levels of fibroblast growth factor 23 (FGF23) and 25-hydroxyvitamin D (25 D) in 184 African American and 327 non-African American hemodialysis patients who enrolled between 1995 and 1998 in the Choices for Healthy Outcomes in Caring for ESRD Study. Serum calcium, phosphorus, parathyroid hormone (PTH) and total alkaline phosphatase levels were averaged from clinical measurements during the first 4.5 months of dialysis. We evaluated the associated prospective risk of mortality using multivariable Cox proportional hazards models stratified by race. Results: PTH and total alkaline phosphatase levels were higher, whereas calcium, phosphorus, FGF23 and 25 D levels were lower in African Americans compared to those of non-African Americans. Higher serum phosphorus and FGF23 levels were associated with greater mortality risk overall; however, phosphorus was only associated with risk among African Americans (HR 5.38, 95% CI 2.14-13.55 for quartile 4 vs. 1), but not among non-African Americans (p-interaction = 0.04). FGF23 was associated with mortality in both groups, but more strongly in African Americans (HR 3.91, 95% CI 1.74-8.82 for quartiles 4 vs. 1; p-interaction = 0.09). Serum calcium, PTH, and 25 D levels were not consistently associated with mortality. The lowest and highest quartiles of total alkaline phosphatase were associated with higher mortality risk, but this did not differ by race (p-interaction = 0.97). Conclusions: Aberrant phosphorus homeostasis, reflected by higher phosphorus and FGF23, may be a risk factor for mortality in patients initiating hemodialysis, particularly among African Americans.

Copyright information:

© 2015 S. Karger AG, Basel.

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