BACKGROUND AND OBJECTIVES: High serum levels of fibroblast growth factor-23 (FGF-23) are associated with mortality in patients with ESRD, but whether it still acts as a phosphaturic factor is unknown. This study aimed to explore the role of circulating FGF-23 on urinary phosphate excretion and phosphate balance in maintenance hemodialysis (MHD) patients with residual renal function (RRF). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: There were 134 MHD patients enrolled in this cross-sectional study from June to July 2010. Demographics, laboratory data, and excretion capacity of phosphate were recorded. Multivariable linear regression was used to analyze the relationship of serum phosphate and the tubular reabsorption rate of phosphate with other factors. RESULTS: The median age of the patients was 61.0 years and 47.8% were male. Thirty percent of the patients had high urinary output (>200 ml/d) accompanied by lower serum levels of phosphate, calcium, intact parathyroid hormone, and FGF-23 compared with those with low urine output (≤200 ml/d). The independent predictors of serum phosphate were normalized protein nitrogen appearance, intact parathyroid hormone, and FGF-23 in the low urine output group and female sex and GFR in the high urine output group. The tubular reabsorption rate of phosphate decreased to 50% of the normal level in patients with RRF. Elevated circulating FGF-23 was significantly associated with lower tubular phosphate reabsorption after adjusting for GFR. CONCLUSIONS: RRF is associated with significant capacity to excrete phosphate in MHD patients and high levels of serum FGF-23 may promote phosphate excretion by remnant nephrons.
BACKGROUND AND OBJECTIVES: High serum levels of fibroblast growth factor-23 (FGF-23) are associated with mortality in patients with ESRD, but whether it still acts as a phosphaturic factor is unknown. This study aimed to explore the role of circulating FGF-23 on urinary phosphate excretion and phosphate balance in maintenance hemodialysis (MHD) patients with residual renal function (RRF). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: There were 134 MHD patients enrolled in this cross-sectional study from June to July 2010. Demographics, laboratory data, and excretion capacity of phosphate were recorded. Multivariable linear regression was used to analyze the relationship of serum phosphate and the tubular reabsorption rate of phosphate with other factors. RESULTS: The median age of the patients was 61.0 years and 47.8% were male. Thirty percent of the patients had high urinary output (>200 ml/d) accompanied by lower serum levels of phosphate, calcium, intact parathyroid hormone, and FGF-23 compared with those with low urine output (≤200 ml/d). The independent predictors of serum phosphate were normalized protein nitrogen appearance, intact parathyroid hormone, and FGF-23 in the low urine output group and female sex and GFR in the high urine output group. The tubular reabsorption rate of phosphate decreased to 50% of the normal level in patients with RRF. Elevated circulating FGF-23 was significantly associated with lower tubular phosphate reabsorption after adjusting for GFR. CONCLUSIONS: RRF is associated with significant capacity to excrete phosphate in MHD patients and high levels of serum FGF-23 may promote phosphate excretion by remnant nephrons.
Authors: Zachary Z Brener; Peter Kotanko; Stephan Thijssen; James F Winchester; Michael Bergman Journal: Am J Med Sci Date: 2010-05 Impact factor: 2.378
Authors: E Lars Penne; Neelke C van der Weerd; Muriel P C Grooteman; Albert H A Mazairac; Marinus A van den Dorpel; Menso J Nubé; Michiel L Bots; Renée Lévesque; Piet M ter Wee; Peter J Blankestijn Journal: Clin J Am Soc Nephrol Date: 2010-10-28 Impact factor: 8.237
Authors: Ebele M Umeukeje; Joseph R Merighi; Teri Browne; Marcus Wild; Hafez Alsmaan; Kausik Umanath; Julia B Lewis; Kenneth A Wallston; Kerri L Cavanaugh Journal: J Behav Med Date: 2016-05-11
Authors: Kamyar Kalantar-Zadeh; Mark Unruh; Philip G Zager; Csaba P Kovesdy; Joanne M Bargman; Jing Chen; Suresh Sankarasubbaiyan; Gaurang Shah; Thomas Golper; Richard A Sherman; David S Goldfarb Journal: Am J Kidney Dis Date: 2014-05-17 Impact factor: 8.860
Authors: Harin Rhee; Ji Young Yang; Woo Jin Jung; Min Ji Shin; Byung Yoon Yang; Sang Heon Song; Ihm Soo Kwak; Eun Young Seong Journal: Kidney Res Clin Pract Date: 2014-03-12