Trends in Mineral Metabolism: Kidney Early Evaluation Program (KEEP) and the National Health and Nutrition Examination Survey (NHANES) 1999-2004

Joseph A. Vassalotti, Jaime Uribarri, Shu Cheng Chen, Suying Li, Changchun Wang, Allan J. Collins, Mona S. Calvo, Adam T. Whaley-Connell, Peter A. McCullough, Keith C. Norris

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Background: Chronic kidney disease (CKD) is associated with mineral metabolism dysregulation, cardiovascular disease, and premature mortality. No study specifically examined mineral metabolism trends in a generalizable sample of patients at increased CKD risk. Methods: This cross-sectional analysis from November 1, 2005, to December 31, 2006, of calcium, phosphorus, and parathyroid hormone (PTH) includes 2,646 individuals with estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 in the National Kidney Foundation Kidney Early Evaluation Program (KEEP), a community-based health-screening program targeting individuals 18 years and older with diabetes, hypertension, or family history of kidney disease, diabetes, or hypertension. A parallel analysis of National Health and Nutrition Examination Survey (NHANES) 1999-2004 data was performed. Results: In KEEP, as eGFR decreased from 55 to less than 60 mL/min/1.73 m2 to less than 30 mL/min/1.73 m2, calcium level decreased (9.55 ± 0.47 to 9.34 ± 0.62 mg/dL; P < 0.001), phosphorus level increased (3.70 ± 0.59 to 4.15 ± 0.80 mg/dL; P < 0.001), and PTH level increased (66.3 ± 36.3 to 164 ± 109 pg/mL; mean, 80.8 ± 57.0 pg/mL; P < 0.001). NHANES 1999-2004 showed similar trends, with PTH values not as high. Individuals within opinion-based Kidney Disease Outcomes Quality Initiatives targets from the highest to the lowest eGFR group were as follows: calcium, 93.0% to 92.3% (KEEP) and 97.4% to 89.6% (NHANES); phosphorus, 90.4% to 90.3% (KEEP) and 91.6% to 87.1% (NHANES); and PTH, 46.1% to 31.2% (KEEP) and 56.4% to 36.1% (NHANES). Conclusions: In a community-based CKD screening population, increased PTH level occurs early in patients with stage 3, typically with normal calcium and phosphorus levels. These findings support the importance of including PTH with calcium and phosphorus monitoring for individuals with eGFR less than 60 mL/min/1.73 m2.

Original languageEnglish
Pages (from-to)S56-S68
JournalAmerican Journal of Kidney Diseases
Issue number4 SUPPL. 2
StatePublished - Apr 2008


  • Calcium
  • Kidney Early Evaluation Program (KEEP)
  • National Health and Nutrition Examination Survey (NHANES)
  • chronic kidney disease
  • mineral metabolism
  • parathyroid hormone (PTH)
  • phosphorus


Dive into the research topics of 'Trends in Mineral Metabolism: Kidney Early Evaluation Program (KEEP) and the National Health and Nutrition Examination Survey (NHANES) 1999-2004'. Together they form a unique fingerprint.

Cite this