Fibroblast growth factor 23 and markers of mineral metabolism in individuals with preserved renal function

被引:55
|
作者
Dhayat, Nasser A. [1 ,10 ,11 ]
Ackermann, Daniel [1 ,11 ]
Pruijm, Menno [2 ]
Ponte, Belen [3 ]
Ehret, Georg [4 ]
Guessous, Idris [5 ,6 ]
Leichtle, Alexander Benedikt [7 ,11 ]
Paccaud, Fred [6 ]
Mohaupt, Markus [1 ]
Fiedler, Georg-Martin [7 ,11 ]
Devuyst, Olivier [8 ]
Pechere-Bertschi, Antoinette [9 ]
Burnier, Michel [2 ,11 ]
Martin, Pierre-Yves [3 ]
Bochud, Murielle [6 ]
Vogt, Bruno [1 ,11 ]
Fuster, Daniel G. [1 ,10 ,11 ]
机构
[1] Univ Bern, Univ Hosp Bern, Dept Nephrol Hypertens & Clin Pharmacol, Bern, Switzerland
[2] Univ Lausanne Hosp, Serv Nephrol, Lausanne, Switzerland
[3] Univ Hosp Geneva, Dept Specialties Internal Med, Serv Nephrol, Geneva, Switzerland
[4] Univ Hosp Geneva, Dept Specialties Internal Med, Serv Cardiol, Geneva, Switzerland
[5] Univ Hosp Geneva, Dept Community Med Primary Care & Emergency Med, Geneva, Switzerland
[6] Univ Lausanne Hosp, Inst Social & Prevent Med, Lausanne, Switzerland
[7] Univ Bern, Univ Hosp Bern, Dept Lab Med, Bern, Switzerland
[8] Univ Zurich, Inst Physiol, Zurich, Switzerland
[9] Univ Hosp Geneva, Dept Internal Med Specialties, Serv Endocrinol, Geneva, Switzerland
[10] Univ Bern, Inst Biochem & Mol Med, Bern, Switzerland
[11] Univ Bern, Dept Clin Res, Bern, Switzerland
基金
瑞士国家科学基金会;
关键词
GLOMERULAR-FILTRATION-RATE; CHRONIC KIDNEY-DISEASE; CARDIOVASCULAR EVENTS; REFERENCE VALUES; COLLABORATIVE METAANALYSIS; PARATHYROID-HORMONE; HIGHER ALBUMINURIA; ALL-CAUSE; PHOSPHATE; MORTALITY;
D O I
10.1016/j.kint.2016.04.024
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that regulates phosphate homeostasis. Circulating FGF23 is elevated in chronic kidney disease (CKD) and independently associated with poor renal and cardiovascular outcomes and mortality. Because the study of FGF23 in individuals with normal renal function has received little attention, we examined in a large, population based study of 1128 participants the associations of FGF23 with markers of mineral metabolism and renal function. The median estimated glomerular filtration rate (eGFR) of the cohort was 105 ml/min per 1.73 m(2), and the median plasma FGF23 was 78.5 RU/ml. FGF23 increased and plasma 1,25-dihydroxyvitamin D3 decreased significantly below an eGFR threshold of 102 and 99 ml/min per 1.73 m(2), respectively. In contrast, plasma parathyroid hormone increased continuously with decreasing eGFR and was first significantly elevated at an eGFR of 126 ml/min per 1.73 m(2). On multivariable analysis adjusting for sex, age, body mass index, and GFR, FGF23 was negatively associated with 1,25-dihydroxyvitamin D3, and urinary absolute and fractional calcium excretion but not with serum calcium or parathyroid hormone. We found a positive association of FGF23 with plasma phosphate, but no association with urinary absolute or fractional phosphate excretion and, unexpectedly, a positive association with tubular maximum phosphate reabsorption/GFR. Thus, in the absence of CKD, parathyroid hormone increases earlier than FGF23 when the eGFR decreases. The increase in FGF23 occurs at a higher eGFR threshold than previously reported and is closely associated with a decrease in 1,25-dihydroxyvitamin D3. We speculate that the main demonstrable effect of FGF23 in the setting of preserved renal function is suppression of 1,25-dihydroxyvitamin D3 rather than stimulation of renal phosphate excretion.
引用
收藏
页码:648 / 657
页数:10
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