My research focuses on 1) describing the chronic kidney disease-mineral bone disorder (CKD-MBD), 2) identifying alternative markers of vitamin D adequacy and bone health, 3) evaluating the relationship between phosphate in the diet and the blood with bone and vascular disease. My clinical interests include the utility of bone biopsy in the management of the CKD-MBD as well as in severe osteoporosis. I have been funded by the National Institute of Health and the American Society of Nephrology.
Vitamin D and Chronic Kidney Disease
Over the last 20 years the number of persons in the United States taking a vitamin D supplement has increased from about 4% to almost 20%. Vitamin D supplementation is especially common in patients with chronic kidney disease, as they are at higher risk of fracture and vitamin D is primarily activated in the kidney. However Vitamin D supplementation and higher Vitamin D levels have not been shown to necessarily improve bone health. My research aims to find alternative markers of vitamin D that better reflect true vitamin D stores and better identify patients that would benefit from vitamin D supplementation. As one of the only medical centers in the U.S to offer bone biopsies to patients with severe bone disease, we have access to unique data that allows us to better identify markers of vitamin D and bone health, using these specimens to guide our investigation.
Phosphate and CKD
Multiple studies have shown that persons with higher phosphate levels in their blood are associated with increased risk of cardiovascular disease and death. This is especially a problem in patients with kidney disease, as the kidney is the primary way the body excretes excess phosphate. Unfortunately, studies evaluating ways to lower phosphate and improve cardiovascular health have not yielded meaningful improvements in clinical outcomes. I am interested in how elevated phosphate levels lead to increased risk of cardiovascular disease and death, with the hope that understanding this pathway will improve our ability to deal with this problem. I study the effects of phosphate on hormonal abnormalities in chronic kidney disease, specifically fibroblast growth factor 23 and parathyroid hormone. Additionally I am interested in the differential effects of phosphate on large and small blood vessels in humans.
A full list of Dr. Ginsberg’s publications can be found here