Parathyroid hormone (PTH) levels increase with progressive stages of chronic kidney disease (CKD) significantly more in African Americans (AA) than in patients of other races, new study findings suggest. This racial difference is apparent as early as stage 2 CKD.

In addition, the study demonstrated that only a moderate component of the PTH increase in AA is explained by changes in serum calcium, phosphorus, and 25-hydroxyvitamin D (25-D), according to a report in Nephrology Dialysis Transplantation (published online ahead of print). The findings are important “because PTH is used as a gauge of CKD mineral bone disorder, a gauge that can drive therapeutic interventions,” the researchers wrote. “Almost certainly, the weight of evidence suggests that use of this gauge must be selective in relation to AA race, an issue that has not yet been addressed in any clinical guidelines.”

Jennifer Ennis, MD, of Litholink Corp., Chicago, a subsidiary of LabCorp, and colleagues analyzed data from 2,028 CKD patients from primary care and nephrology practices across the United States. Of the 2,028 patients, 505 were AA.

The mean PTH was significantly higher for AA than for non-AA in each successive stage of CKD, beginning with stage 2. Results showed that 25-D levels were significantly higher for non-AA in CKD stages 1-3. Serum calcium and phosphorus did not differ between the groups at any stage. Serum calcium, phosphorus, and 25-D were inversely correlated with PTH levels regardless of race, but all factors combined accounted for approximately 42% of the variance in PTH, Dr. Ennis' group reported.

The new findings supplement those of previous studies. For example, in a study of 218 patients in an ethnically diverse ambulatory nephrology practice at the University of California-San Francisco, Ian H. De Boer, MD, and colleagues found that the adjusted mean PTH was significantly higher among AA compared with whites (233 vs. 139 pg/mL). Among patients with an estimated glomerular filtration rate (GFR) below 60 mL/min/1.73 m², the slope of GFR vs. PTH was significantly steeper among AA than whites, according to a report in the Journal of the American Society of Nephrology (2002;13:2762-2769).

Dr. Ennis and her group pointed to some important limitations of their study. For example, urine data and information on diet were unavailable, and medication information was unavailable for only 42% of cases. The researchers did not have information about socioeconomic status, body mass index, and smoking status.

Furthermore, they noted that because of the cross-sectional design of the study, patients may have been at various stages of treatment of CKD mineral bone disorder. “Consequently, the ability to generalize about the natural history of CKD and its implications on mineral metabolism is limited,” they wrote.

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Fresenius Medical Care (FMC), the world's leading supplier of renal care products and services, said Thursday it was confirming its outlook for the current year after a strong first quarter.

FMC, which publishes its accounts in US dollars, said in a statement that bottom-line net profit soared by 68 percent to $370 million (279 million euros) in the period from January to March on a 9.0-percent increase in sales to $3.249 billion.

The net profit figure was, however, inflated by an investment gain of $127 million related to the acquisition of Liberty Dialysis holdings, the statement explained.

Excluding this one-off factor, net profit grew by 10 percent to $244 million.

On the back of this "strong operating performance," FMC said it was sticking to its forecast for full-year sales of around $14 billion and net profit, excluding the investment gain, of $1.14 billion.

In 2011, FMC booked a record net profit of $1.071 million on sales of $12.795 billion.

Separately, FMC's parent company, healthcare group Fresenius, said it was launching a 3.1-billion-euro takeover bid for one of Germany's largest private hospital operators Rhoen-Klinikum AG.

Rhoen-Klinikum has annual sales of 2.6 billion euros and net profit of 161 million euros and operates some 53 hospitals with around 16,000 beds.

Fresenius plans to merge it with its HELIOS group of hospitals to create the country's largest private hospital operator.

Fresenius, which publishes its accounts in euros, said it, too, got off to an "excellent" start to 2012, with net profit jumping 18 percent to 200 million euros on a 13-percent increase in sales to 4.419 billion euros in the first three months.

On the basis of that strong performance, Fresenius said it was raising its full-year forecasts and was now projecting net income growth of 12-15 percent, instead of eight-12 percent previously.

Sales were expected to come out at the upper end of the forecast range of 10-13 percent, Fresenius added.

In 2011, Fresenius booked net profit of 770 million euros on sales of 16.5 billion euros.

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