LAS VEGAS—Disordered mineral metabolism starts earlier in the course of chronic kidney disease (CKD) and is more severe in patients with diabetes than in those without diabetes, investigators reported at the National Kidney Foundation’s Spring Clinical Meetings.

In a study of 3,879 participants in the Chronic Renal Insufficiency Cohort study, the estimated glomerular filtration rate (eGFR) at which 50% of subjects met criteria for secondary hyperparathyroidism was significantly higher in diabetics than in nondiabetics (eGFR 30-39 vs. 20-29 mL/min/1.73 m2). The study, by Patricia Wahl, PhD, and collaborators at the University of Miami Miller School of Medicine, also showed that, among patients with diabetes, 50% already had elevated fibroblast growth factor 23 (FGF-23) at an eGFR of 50-59 versus an eGFR of 40-49 for nondiabetics.

Of the 3,879 subjects, 1,879 had diabetes and 2,000 did not. At an eGFR of 45-59 and 30-44, diabetics had significantly higher levels of parathyroid hormone (PTH). In all eGFR categories, diabetics had significantly higher phosphate levels and FGF-23.

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In adjusted analyses, diabetes was a significant determinant of parathyroid hormone, phosphate, and FGF-23