Racial disparaties in ESRD: Bone Disease & Morbidity

终末期肾病(ESRD)的发病率和患病率每年都在增加，其中非裔美国人受到的影响不成比例。终末期肾病患者存在许多代谢异常，包括钙、磷、碳酸氢盐和甲状旁腺激素(PTH)水平异常。众所周知，非裔美国人的甲状旁腺激素水平高于高加索人。目前尚不清楚这种升高是否具有临床意义，也不清楚非裔美国人和白人患者是否应该有不同的甲状旁腺激素目标。梅拉米德博士计划分析NIDDK资助的ESRD健康结局研究(CHOICE)的数据，以调查非裔美国人和高加索人的骨病参数。她打算获得有关髋部骨折住院和心血管发病率和死亡率的数据，并调查与甲状旁腺素水平和维生素D替代疗法的关系。此外，为了调查慢性肾脏疾病骨密度降低的决定因素，她计划分析第三次全国健康与营养检查调查中有关炎症和酸中毒的数据。

End-stage renal disease (ESRD) is increasing in incidence and prevalence every year with African Americans disproportionately affected. Patients with ESRD experience many metabolic abnormalities including abnormal calcium, phosphate, bicarbonate and parathyroid hormone (PTH)levels. African Americans are known to have higher levels of parathyroid hormone than Caucasians. It is unclear whether this elevation is of clinical significance and whether there should be different parathyroid hormone goals for African Americans versus Caucasian patients. Dr. Melamed plans to analyze data from the Choices for Healthy Outcomes in Caring for ESRD (CHOICE), an NIDDK-funded study, to investigate the bone disease parameters in African Americans and Caucasians. She intends to obtain data regarding hospital admissions for hip fractures and cardiovascular morbidity and mortality and investigate associations with PTH levels and vitamin D replacement therapy. In addition, in order to investigate determinants of lower bone mineral density in chronic kidney disease she plans to analyze data on inflammation and acidosis from the Third national Health and Nutrition Examination Survey.