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Biomarkers of Mineral and Bone Metabolism and 20-Year Risk of Hospitalization With Infection: The Atherosclerosis Risk in Communities Study.

TitleBiomarkers of Mineral and Bone Metabolism and 20-Year Risk of Hospitalization With Infection: The Atherosclerosis Risk in Communities Study.
Publication TypeJournal Article
Year of Publication2017
AuthorsIshigami J, Jaar BG, Rebholz CM, Grams ME, Michos ED, Wolf M, Kovesdy CP, Uchida S, Coresh JJ, Lutsey PL
Secondary AuthorsMatsushita K
JournalJ Clin Endocrinol Metab
Volume102
Issue12
Pagination4648-4657
Date Published2017 12 01
ISSN1945-7197
KeywordsAtherosclerosis, Biomarkers, Bone and Bones, Cohort Studies, Cross-Sectional Studies, Female, Fibroblast Growth Factors, Glomerular Filtration Rate, Hospitalization, Humans, Incidence, Infections, Longitudinal Studies, Male, Middle Aged, Minerals, Parathyroid Hormone, Prospective Studies, Risk Assessment, Vitamin D
Abstract

Context: Mineral and bone disorders (MBDs) might be relevant in the etiology of infection.

Objective: To determine whether MBD biomarkers were associated with the incidence of hospitalization with infection. We also assessed the cross-sectional association between MBD biomarker levels and kidney function.

Design, Setting, Participants: Community-based cohort study of 11,218 participants with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 in the Atherosclerosis Risk in Communities study. We assessed the cross-sectional associations of five MBD markers-fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), calcium corrected for hypoalbuminemia, and phosphorus-with eGFR from 1990 to 1992 and their longitudinal associations with incident hospitalization with infection in 1990 to 2013.

Main Outcome: Incident hospitalization with infection.

Results: In age-, sex-, and race-adjusted models, lower eGFRs were significantly associated with greater levels of FGF23, PTH, and corrected calcium but not 25(OH)D or phosphorus. During follow-up, 5078 hospitalizations with infection occurred. In fully adjusted Cox models, with the second quartile as the reference, the hazard ratio (HR) was significantly greater in the highest quartile of FGF23 [HR, 1.12; 95% confidence interval (CI), 1.03 to 1.21], PTH (HR, 1.09; 95% CI, 1.01 to 1.18), and corrected calcium (HR, 1.11; 95% CI, 1.03 to 1.20), and lowest quartile for 25(OH)D (HR, 1.11; 95% CI, 1.03 to 1.21). The association with phosphorus was significant only when the outcome was restricted to primary diagnosis of infection. These findings were consistent across subgroups of age, sex, race, and eGFR (

Conclusions: MBD biomarkers were associated with eGFR and the subsequent risk of infection, supporting MBD involvement in the etiology of infection.

DOI10.1210/jc.2017-01868
Alternate JournalJ Clin Endocrinol Metab
PubMed ID29029099
PubMed Central IDPMC5718703
Grant ListK01 DK107782 / DK / NIDDK NIH HHS / United States
T32 HL007024 / HL / NHLBI NIH HHS / United States