Fibroblast Growth Factor 23, Vitamin D, and Health Disparities Among African Americans With Chronic Kidney Disease

SummaryCompared with 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 African Americans are at higher risk of vitamin D deficiency. However, the finding that African Americans maintain better indices of musculoskeletal health than Caucasians 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 straightforward. The fairly recent emergence of fibroblast growth factor 23 (FGF23) may help resolve some of this uncertainty. FGF23 strongly modulates both systemic and local activation of 25(OH)D, playing a potentially important role in the degree to which lower 25(OH)D concentrations impact health outcomes, including differences in the incidence and rate of progression of chronic kidney disease by race. This review critically assesses ongoing controversies surrounding the relationship between vitamin D and racial disparities in chronic kidney disease outcomes, and how FGF23 may help to clarify the picture.