Investigators have identified racial disparities in secondary hyperparathyroidism (SHPT) biomarkers among children and adolescents receiving dialysis that appear similar to trends seen in adult patients.
In a recent study of 661 patients (younger than age 21 years) in their first year of hemodialysis or peritoneal dialysis, African Americans and Hispanics had 23% and 17.5% higher serum parathyroid hormone levels (PTH), respectively, than Caucasians. Differences were particularly pronounced among girls, Isidro B. Salusky, MD, of the University of California, Los Angeles, and colleagues reported in Pediatric Nephrology. Female African-American and Hispanic patients had 38% and 28.8% higher PTH values than Caucasians, respectively. Yet black girls displayed 10.9% lower total alkaline phosphatase activity than white girls. Calcium levels were similar between black and white patients, whereas phosphate levels were lower for blacks.
According to the researchers, disparities in mineral and bone metabolism might spring from underlying biological differences, social factors that influence calcium and phosphate intake, and differences in access to care. They argued against increasing active vitamin D doses in African Americans as it potentially contributes to low bone turnover.
“There is a need to consider how factors like race, ethnicity, and gender impact the goal-targeted treatment of MBM disorders,” Dr Salusky and the team concluded.
The investigators acknowledged that broad racial categories fail to capture mixed lineage. The study also lacked data on patients’ vitamin D status.
Laster M, Soohoo M, Streja E, et al. Racial-ethnic differences in chronic kidney disease-mineral bone disorder in youth on dialysis. Ped Nephrol. DOI:10.1007/s00467-018-4048-6