FGF23, PTH and Phosphorus Metabolism in the Chronic Renal Insufficiency Cohort

By T. Isakova, P. Wahl, Gabriela Vargas, O. Gutiérrez, J. Scialla, Huiliang Xie, D. Appleby, L. Nessel, K. Bellovich, J. Chen and 9 more. Kidney International, 2011

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Fibroblast growth factor 23 (FGF23) regulates phosphorus metabolism and is a strong predictor of mortality in dialysis patients. FGF23 has been proposed as an early biomarker of disordered phosphorus metabolism in earlier stages of chronic kidney disease (CKD), but data from large, well-characterized CKD cohorts are lacking. We measured FGF23 in baseline samples from 3,879 participants in the Chronic Renal Insufficiency Cohort study, a nationally representative, diverse CKD cohort with mean (± sd) estimated glomerular filtration rate (eGFR) of 42.8 ± 13.5 ml/min/1.73m2. Serum phosphate (3.7 ± 0.7 mg/dl) and parathyroid hormone (PTH; median 54, interquartile range [IQR] 35 – 89 pg/ml) levels were in the normal range, but FGF23 (median 145, IQR 96 – 239 RU/ml) was markedly greater than in healthy populations and increased significantly with decreasing eGFR. FGF23 excess, defined as ≥ 100 RU/ml, was more common than secondary hyperparathyroidism (≥ 65 pg/ml) and hyperphosphatemia (≥ 4.6 mg/dl) in all strata of eGFR, and the eGFR threshold at which the slope of FGF23 increased (57.8; 95%CI: 55.4 – 60.8 ml/min/1.73m2) was higher than the corresponding threshold for PTH (46.9; 95%CI: 45.5 – 51.4 ml/min/1.73m2). Thus, increased FGF23 is a common manifestation of CKD that develops earlier than increases in phosphate or PTH. These findings provide additional support for use of FGF23 as a sensitive early screening test to identify disordered phosphorus metabolism in CKD patients with normal serum phosphate levels.

Subfields: Genetics, Nephrology, Pathology and Forensic Medicine

View Paper: https://www.semanticscholar.org/paper/5f9f502ef36b0dec1620fbbca5ed2eee442267d3

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Citations in the corpus

FGF/FGFR signaling in health and disease (2020, background): “A secondary elevation of serum FGF23 levels is commonly detected in CKD patients that are partly due to decreased renal clearance.(364) The increased FGF23 is beneficial for lowering serum phosphate level and reducing 1,25(OH)2D3, which further increases the PTH level.”