Abstract
Compared to Caucasians, African Americans have lower circulating concentrations of 25-hydroxyvitamin D (25(OH)D), the major storage form of vitamin D, leading to the widespread assumption that blacks are at higher risk of vitamin D deficiency. Since low 25(OH)D is associated with adverse cardiovascular and kidney outcomes, this has supported the notion that low 25(OH)D concentrations partly underlie racial disparities in health outcomes, including faster progression of chronic kidney disease (CKD) in blacks vs. whites. However, the finding that blacks maintain better indices of musculoskeletal health than whites throughout their lifespan despite having lower circulating 25(OH)D concentrations suggests that the relationship between vitamin D deficiency and racial health disparities may not be so straight forward. This has been further underscored by epidemiologic studies showing major racial heterogeneity in the association of 25(OH)D with cardiovascular outcomes. When coupled with emerging data showing genetically determined differences in the bioavailability of vitamin D by race, these data suggest that there are important differences in vitamin D metabolism by race which need to inform and perhaps revise our current understanding of the role of vitamin D in racial disparities in CKD outcomes.
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References
Holick MF. Vitamin D, deficiency. N Engl J Med. 2007;357:266ā81.
Resnick LM, Muller FB, Laragh JH. Calcium-regulating hormones in essential hypertension. Relation to plasma renin activity and sodium metabolism. Ann Intern Med. 1986;105:649ā54.
Vaidya A, Williams JS. The relationship between vitamin D and the renin-angiotensin system in the pathophysiology of hypertension, kidney disease, and diabetes. Metabolism. 2012;61:450ā8.
Judd SE, Nanes MS, Ziegler TR, et al. Optimal vitamin D status attenuates the age-associated increase in systolic blood pressure in white Americans: results from the third National Health and Nutrition Examination Survey. Am J Clin Nutr. 2008;87:136ā41.
Martins D, Wolf M, Pan D, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007;167:1159ā65.
Hypponen E, Boucher BJ, Berry DJ, et al. 25-hydroxyvitamin D, IGF-1, and metabolic syndrome at 45 years of age: a cross-sectional study in the 1958 British Birth Cohort. Diabetes. 2008;57:298ā305.
Hintzpeter B, Mensink GB, Thierfelder W, et al. Vitamin D status and health correlates among German adults. Eur J Clin Nutr. 2008;62:1079ā89.
Pasco JA, Henry MJ, Nicholson GC, et al. Behavioural and physical characteristics associated with vitamin D status in women. Bone. 2009;44:1085ā91.
Forouhi NG, Luan J, Cooper A, et al. Baseline serum 25-hydroxy vitamin d is predictive of future glycemic status and insulin resistance: the Medical Research Council Ely Prospective Study 1990ā2000. Diabetes. 2008;57:2619ā25.
Gannage-Yared MH, Chedid R, Khalife S, et al. Vitamin D in relation to metabolic risk factors, insulin sensitivity and adiponectin in a young Middle-Eastern population. Eur J Endocrinol. 2009;160:965ā71.
Forman JP, Giovannucci E, Holmes MD, et al. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension. 2007;49:1063ā9.
Patel RS, Al Mheid I, Morris AA, et al. Oxidative stress is associated with impaired arterial elasticity. Atherosclerosis. 2011;218:90ā5.
Al Mheid I, Patel R, Murrow J, et al. Vitamin D status is associated with arterial stiffness and vascular dysfunction in healthy humans. J Am Coll Cardiol. 2011;58:186ā92.
Melamed ML, Michos ED, Post W, et al. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008;168:1629ā37.
Pilz S, Dobnig H, Fischer JE, et al. Low vitamin d levels predict stroke in patients referred to coronary angiography. Stroke. 2008;39:2611ā3.
Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008;117:503ā11.
Giovannucci E, Liu Y, Hollis BW, et al. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168:1174ā80.
Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168:1340ā9.
Pilz S, Dobnig H, Nijpels G, et al. Vitamin D and mortality in older men and women. Clin Endocrinol (Oxf). 2009;71:666ā72.
Marniemi J, Alanen E, Impivaara O, et al. Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects. Nutr Metab Cardiovasc Dis. 2005;15:188ā97.
Pilz S, Marz W, Wellnitz B, et al. Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab. 2008;93:3927ā35.
Ginde AA, Scragg R, Schwartz RS, et al. Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all-cause mortality in older U.S. adults. J Am Geriatr Soc. 2009;57:1595ā603.
Kilkkinen A, Knekt P, Aro A, et al. Vitamin D status and the risk of cardiovascular disease death. Am J Epidemiol. 2009;170:1032ā9.
Semba RD, Houston DK, Bandinelli S, et al. Relationship of 25-hydroxyvitamin D with all-cause and cardiovascular disease mortality in older community-dwelling adults. Eur J Clin Nutr. 2010;64:203ā9.
Anderson JL, May HT, Horne BD, et al. Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol. 2010;106:963ā8.
Cawthon PM, Parimi N, Barrett-Connor E, et al. Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men. J Clin Endocrinol Metab. 2010;95:4625ā34.
Michaelsson K, Baron JA, Snellman G, et al. Plasma vitamin D and mortality in older men: a community-based prospective cohort study. Am J Clin Nutr. 2010;92:841ā8.
Hutchinson MS, Grimnes G, Joakimsen RM, et al. Low serum 25-hydroxyvitamin D levels are associated with increased all-cause mortality risk in a general population: the Tromso study. Eur J Endocrinol. 2010;162:935ā42.
Kestenbaum B, Katz R, de Boer I, et al. Vitamin D, parathyroid hormone, and cardiovascular events among older adults. J Am Coll Cardiol. 2011;58:1433ā41.
Deo R, Katz R, Shlipak MG, et al. Vitamin D, parathyroid hormone, and sudden cardiac death: results from the Cardiovascular Health Study. Hypertension. 2011;58:1021ā8.
Michos ED, Reis JP, Post WS, et al. 25-Hydroxyvitamin D deficiency is associated with fatal stroke among whites but not blacks: the NHANES-III linked mortality files. Nutrition. 2012;28:367ā71.
Robinson-Cohen C, Hoofnagle AN, Ix JH, et al. Racial differences in the association of serum 25-hydroxyvitamin D concentration with coronary heart disease events. JAMA. 2013;310:179ā88.
de Boer IH, Levin G, Robinson-Cohen C, et al. Serum 25-hydroxyvitamin D concentration and risk for major clinical disease events in a community-based population of older adults: a cohort study. Ann Intern Med. 2012;156:627ā34.
de Boer IH, Kestenbaum B, Shoben AB, et al. 25-hydroxyvitamin D levels inversely associate with risk for developing coronary artery calcification. J Am Soc Nephrol. 2009;20:1805ā12.
Harris SS. Vitamin D, and African Americans. J Nutr. 2006;136:1126ā9.
Melamed ML, Astor B, Michos ED, et al. 25-hydroxyvitamin D levels, race, and the progression of kidney disease. J Am Soc Nephrol. 2009;20:2631ā9.
Baron JA, Barrett J, Malenka D, et al. Racial differences in fracture risk. Epidemiology. 1994;5:42ā7.
Farmer ME, White LR, Brody JA, et al. Race and sex differences in hip fracture incidence. Am J Public Health. 1984;74:1374ā80.
Moldawer M, Zimmerman SJ, Collins LC. Incidence of osteoporosis in elderly whites and elderly Negroes. JAMA. 1965;194:859ā62.
Silverman SL, Madison RE. Decreased incidence of hip fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data. Am J Public Health. 1988;78:1482ā3.
Barrett-Connor E, Siris ES, Wehren LE, et al. Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res. 2005;20:185ā94.
Glerup H, Mikkelsen K, Poulsen L, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int. 2000;66:419ā24.
Schott GD, Wills MR. Muscle weakness in osteomalacia. Lancet. 1976;1:626ā9.
Bischoff-Ferrari HA, Dietrich T, Orav EJ, et al. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr. 2004;80:752ā8.
Wicherts IS, van Schoor NM, Boeke AJ, et al. Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab. 2007;92:2058ā65.
Ensrud KE, Ewing SK, Fredman L, et al. Circulating 25-hydroxyvitamin D levels and frailty status in older women. J Clin Endocrinol Metab. 2010;95:5266ā73.
Aloia JF. African Americans, 25-hydroxyvitamin D, and osteoporosis: a paradox. Am J Clin Nutr. 2008;88:545Sā50S.
Scragg R, Sowers M, Bell C, et al. Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care. 2004;27:2813ā8.
Gutierrez OM, Isakova T, Andress DL, et al. Prevalence and severity of disordered mineral metabolism in Blacks with chronic kidney disease. Kidney Int. 2008;73:956ā62.
Egan KM, Signorello LB, Munro HM, et al. Vitamin D insufficiency among African-Americans in the southeastern United States: implications for cancer disparities (United States). Cancer Causes Control CCC. 2008;19:527ā35.
Fiscella K, Winters P, Tancredi D, et al. Racial disparity in blood pressure: is vitamin D a factor? J Gen Intern Med. 2011;26:1105ā11.
Fiscella KA, Winters PC, Ogedegbe G. Vitamin D and racial disparity in albuminuria: NHANES 2001ā2006. Am J Hypertens. 2011;24:1114ā20.
Reis JP, Michos ED, von Muhlen D, et al. Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease. Am J Clin Nutr. 2008;88:1469ā77.
Rostand SG. Ultraviolet light may contribute to geographic and racial blood pressure differences. Hypertension. 1997;30:150ā6.
Kritchevsky SB, Tooze JA, Neiberg RH, et al. 25-Hydroxyvitamin D, parathyroid hormone, and mortality in black and white older adults: the health ABC study. J Clin Endocrinol Metab. 2012;97:4156ā65.
Williams SK, Fiscella K, Winters P, et al. Association of racial disparities in the prevalence of insulin resistance with racial disparities in vitamin D levels: National Health and Nutrition Examination Survey (2001ā2006). Nutr Res. 2013;33:266ā71.
Bertisch SM, Sillau S, de Boer IH, et al. 25-hydroxyvitamin D concentration and sleep duration and continuity: multi-ethnic study of atherosclerosis. Sleep. 2015;38:1305ā11.
Navaneethan SD, Schold JD, Arrigain S, et al. Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD. Am J Kidney Dis. 2011;58:536ā43.
Fernandez-Juarez G, Luno J, Barrio V, et al. 25 (OH) vitamin D levels and renal disease progression in patients with type 2 diabetic nephropathy and blockade of the renin-angiotensin system. Clin J Am Soc Nephrol. 2013;8:1870ā6.
Shroff R, Aitkenhead H, Costa N, et al. Normal 25-hydroxyvitamin D levels are associated with less proteinuria and attenuate renal failure progression in children with CKD. J Am Soc Nephrol. 2016;27:314ā22.
de Boer IH, Katz R, Chonchol M, et al. Serum 25-hydroxyvitamin D and change in estimated glomerular filtration rate. Clin J Am Soc Nephrol. 2011;6:2141ā9.
Wolf M, Betancourt J, Chang Y, et al. Impact of activated vitamin D and race on survival among hemodialysis patients. J Am Soc Nephrol. 2008;19:1379ā88.
Kalantar-Zadeh K, Miller JE, Kovesdy CP, et al. Impact of race on hyperparathyroidism, mineral disarrays, administered vitamin D mimetic, and survival in hemodialysis patients. J Bone Miner Res. 2010;25:2724ā34.
Gutierrez OM. Fibroblast growth factor 23 and disordered vitamin D metabolism in chronic kidney disease: updating the ātrade-offā hypothesis. Clin J Am Soc Nephrol. 2010;5:1710ā6.
Bringhurst FR, Demay MB, Kronenberg HM. Williams textbook of endocrinology. 12th ed. Philadelphia: Elsevier Saunders; 2011.
Gutierrez OM, Farwell WR, Kermah D, et al. Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the National Health and Nutrition Examination Survey. Osteoporos Int. 2011;22:1745ā53.
Awumey EM, Mitra DA, Hollis BW, et al. Vitamin D metabolism is altered in Asian Indians in the southern United States: a clinical research center study. J Clin Endocrinol Metab. 1998;83:169ā73.
Bikle DD, Gee E, Halloran B, et al. Assessment of the free fraction of 25-hydroxyvitamin D in serum and its regulation by albumin and the vitamin D-binding protein. J Clin Endocrinol Metab. 1986;63:954ā9.
Safadi FF, Thornton P, Magiera H, et al. Osteopathy and resistance to vitamin D toxicity in mice null for vitamin D binding protein. J Clin Invest. 1999;103:239ā51.
Braun A, Bichlmaier R, Cleve H. Molecular analysis of the gene for the human vitamin-D-binding protein (group-specific component): allelic differences of the common genetic GC types. Hum Genet. 1992;89:401ā6.
Bhan I. Vitamin d binding protein and bone health. Int J Endocrinol. 2014;2014:561214.
Powe CE, Evans MK, Wenger J, et al. Vitamin D-binding protein and vitamin D status of black Americans and white Americans. N Engl J Med. 2013;369:1991ā2000.
Mendel CM. The free hormone hypothesis: a physiologically based mathematical model. Endocr Rev. 1989;10:232ā74.
Bikle DD, Siiteri PK, Ryzen E, et al. Serum protein binding of 1,25-dihydroxyvitamin D: a reevaluation by direct measurement of free metabolite levels. J Clin Endocrinol Metab. 1985;61:969ā75.
Chun RF, Lauridsen AL, Suon L, et al. Vitamin D-binding protein directs monocyte responses to 25-hydroxy- and 1,25-dihydroxyvitamin D. J Clin Endocrinol Metab. 2010;95:3368ā76.
Chun RF, Peercy BE, Adams JS, et al. Vitamin D binding protein and monocyte response to 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D: analysis by mathematical modeling. PLoS One. 2012;7:e30773.
Zella LA, Shevde NK, Hollis BW, et al. Vitamin D-binding protein influences total circulating levels of 1,25-dihydroxyvitamin D3 but does not directly modulate the bioactive levels of the hormone in vivo. Endocrinology. 2008;149:3656ā67.
Powe CE, Ricciardi C, Berg AH, et al. Vitamin D-binding protein modifies the vitamin D-bone mineral density relationship. J Bone Miner Res. 2011;26:1609ā16.
Bhan I, Powe CE, Berg AH, et al. Bioavailable vitamin D is more tightly linked to mineral metabolism than total vitamin D in incident hemodialysis patients. Kidney Int. 2012;82:84.
Christakos S, Dhawan P, Porta A, et al. Vitamin D and intestinal calcium absorption. Mol Cell Endocrinol. 2011;347:25ā9.
Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest. 2006;116:2062ā72.
Aloia JF, Vaswani A, Ma R, et al. Comparison of body composition in black and white premenopausal women. J Lab Clin Med. 1997;129:294ā9.
Bachrach LK, Hastie T, Wang MC, et al. Bone mineral acquisition in healthy Asian, Hispanic, black, and Caucasian youth: a longitudinal study. J Clin Endocrinol Metab. 1999;84:4702ā12.
Nelson DA, Jacobsen G, Barondess DA, et al. Ethnic differences in regional bone density, hip axis length, and lifestyle variables among healthy black and white men. J Bone Miner Res. 1995;10:782ā7.
Aloia JF, Vaswani A, Delerme-Pagan C, et al. Discordance between ultrasound of the calcaneus and bone mineral density in black and white women. Calcif Tissue Int. 1998;62:481ā5.
Aloia JF, Vaswani A, Yeh JK, et al. Risk for osteoporosis in black women. Calcif Tissue Int. 1996;59:415ā23.
Bell NH, Shary J, Stevens J, et al. Demonstration that bone mass is greater in black than in white children. J Bone Miner Res. 1991;6:719ā23.
Harris SS, Wood MJ, Dawson-Hughes B. Bone mineral density of the total body and forearm in premenopausal black and white women. Bone. 1995;16:311Sā5S.
Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8:468ā89.
Luckey MM, Meier DE, Mandeli JP, et al. Radial and vertebral bone density in white and black women: evidence for racial differences in premenopausal bone homeostasis. J Clin Endocrinol Metab. 1989;69:762ā70.
Pollitzer WS, Anderson JJ. Ethnic and genetic differences in bone mass: a review with a hereditary vs environmental perspective. Am J Clin Nutr. 1989;50:1244ā59.
Cauley JA, Gutai JP, Kuller LH, et al. Black-white differences in serum sex hormones and bone mineral density. Am J Epidemiol. 1994;139:1035ā46.
Meier DE, Luckey MM, Wallenstein S, et al. Calcium, vitamin D, and parathyroid hormone status in young white and black women: association with racial differences in bone mass. J Clin Endocrinol Metab. 1991;72:703ā10.
Cauley JA, Lui LY, Ensrud KE, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293:2102ā8.
Barbour KE, Zmuda JM, Horwitz MJ, et al. The association of serum 25-hydroxyvitamin D with indicators of bone quality in men of Caucasian and African ancestry. Osteoporos Int. 2011;22:2475ā85.
Aloia JF, Chen DG, Chen H. The 25(OH)D/PTH threshold in black women. J Clin Endocrinol Metab. 2010;95:5069ā73.
van Ballegooijen AJ, Robinson-Cohen C, Katz R, et al. Vitamin D metabolites and bone mineral density: the multi-ethnic study of atherosclerosis. Bone. 2015;78:186ā93.
Cauley JA, Danielson ME, Boudreau R, et al. Serum 25 hydroxyvitamin (OH)D and clinical fracture risk in a multiethnic Cohort of women: the Womenās health initiative (WHI). J Bone Miner Res. 2011;26:2378.
Dawson-Hughes B. Racial/ethnic considerations in making recommendations for vitamin D for adult and elderly men and women. Am J Clin Nutr. 2004;80:1763Sā6S.
Bell NH, Greene A, Epstein S, et al. Evidence for alteration of the vitamin D-endocrine system in blacks. J Clin Invest. 1985;76:470ā3.
Dawson-Hughes B, Harris S, Kramich C, et al. Calcium retention and hormone levels in black and white women on high- and low-calcium diets. J Bone Miner Res. 1993;8:779ā87.
Engelman CD, Fingerlin TE, Langefeld CD, et al. Genetic and environmental determinants of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels in Hispanic and African Americans. J Clin Endocrinol Metab. 2008;93:3381ā8.
Cosman F, Nieves J, Dempster D, et al. Vitamin D economy in blacks. J Bone Miner Res. 2007;22 Suppl 2:V34ā8.
Cosman F, Morgan DC, Nieves JW, et al. Resistance to bone resorbing effects of PTH in black women. J Bone Miner Res. 1997;12:958ā66.
Fuleihan GE, Gundberg CM, Gleason R, et al. Racial differences in parathyroid hormone dynamics. J Clin Endocrinol Metab. 1994;79:1642ā7.
Perry 3rd HM, Horowitz M, Morley JE, et al. Aging and bone metabolism in African American and Caucasian women. J Clin Endocrinol Metab. 1996;81:1108ā17.
Bischoff-Ferrari HA, Giovannucci E, Willett WC, et al. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84:18ā28.
Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7:439ā43.
Holick MF, Siris ES, Binkley N, et al. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005;90:3215ā24.
Krall EA, Sahyoun N, Tannenbaum S, et al. Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women. N Engl J Med. 1989;321:1777ā83.
Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet. 1998;351:805ā6.
Steingrimsdottir L, Gunnarsson O, Indridason OS, et al. Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA. 2005;294:2336ā41.
Cauley JA, Lacroix AZ, Wu L, et al. Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med. 2008;149:242ā50.
Cauley JA, Parimi N, Ensrud KE, et al. Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. J Bone Miner Res. 2010;25:545ā53.
Cummings SR, Browner WS, Bauer D, et al. Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1998;339:733ā8.
Looker AC, Mussolino ME. Serum 25-hydroxyvitamin D and hip fracture risk in older U.S. white adults. J Bone Miner Res. 2008;23:143ā50.
Heaney RP. The importance of calcium intake for lifelong skeletal health. Calcif Tissue Int. 2002;70:70ā3.
Targher G, Bertolini L, Padovani R, et al. Serum 25-hydroxyvitamin D3 concentrations and carotid artery intima-media thickness among type 2 diabetic patients. Clin Endocrinol (Oxf). 2006;65:593ā7.
Freedman BI, Wagenknecht LE, Hairston KG, et al. Vitamin d, adiposity, and calcified atherosclerotic plaque in African-Americans. J Clin Endocrinol Metab. 2010;95:1076ā83.
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GutiƩrrez, O.M. (2016). Vitamin D and Racial Differences in Chronic Kidney Disease. In: UreƱa Torres, P., Cozzolino, M., Vervloet, M. (eds) Vitamin D in Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-32507-1_6
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