Katarzyna Muras1, Anna Masajtis-Zagajewska, Michał Nowicki. 1. University Hospital, Medical University of Lodz, Department of Nephrology, Hypertension, and Kidney Transplantation, Kopcinskiego 22, 90-153 Lodz, Poland. nefro@wp.pl.
Abstract
CONTEXT: The pathophysiology of calcium-phosphate disturbances in diabetic (DM) kidney disease differs from that in non-DM chronic kidney disease (CKD). OBJECTIVE: We compared the effect of a 6-day high-phosphate diet on serum fibroblast growth factor-23 (FGF-23) and other parameters of calcium-phosphate metabolism in DM and non-DM CKD patients. DESIGN AND SETTING: This was a prospective interventional study in a research center setting. PARTICIPANTS, INTERVENTION, AND MEASURES: Twenty-six nondialysis patients with stages 3-5 CKD and albuminuria less than 300 mg/g creatinine were recruited from February 2011 to November 2012 (15 DM, 11 non-DM). All patients received a high-phosphate diet (1800 mg/d) for 6 days. At baseline, day 3, and day 7 serum FGF-23, PTH, Ca, P, 25-hydroxyvitamin D, 1,25 dihydroxyvitamin D, monocyte chemoattractant protein-1, and calcium and phosphate urine excretion were measured. RESULTS: In DM CKD patients, serum calcium was lower on days 3 and 7 vs baseline (P < .01, respectively), and in non-DM patients, it was unchanged. Serum phosphorus increased significantly only in non-DM patients on days 3 and 7 vs baseline (P < 0.01, respectively). Serum PTH was higher in the DM group on day 7 vs baseline (P = .04). Plasma 25-hydroxyvitamin D, 1,25 dihydroxyvitamin D, and serum monocyte chemoattractant protein-1 were unchanged in both groups. Serum FGF-23 increased in DM patients, from baseline to day 3 (58.1 ± 52.7 and 91.6 ± 71.1 pg/mL, P = .001) but later tended to decrease. In non-DM patients, there was a steady increase of FGF-23 between baseline and day 7 (75 ± 84.3 to 176 ± 197 pg/mL, P = .04). Urine phosphate excretion was significantly higher on day 7 in DM patients only (P < .05). CONCLUSIONS: PTH seems to play the major role in the regulation of phosphate excretion in DM CKD. The role of FGF-23 in phosphate disposal in DM CKD remains debatable.
CONTEXT: The pathophysiology of calcium-phosphate disturbances in diabetic (DM) kidney disease differs from that in non-DMchronic kidney disease (CKD). OBJECTIVE: We compared the effect of a 6-day high-phosphate diet on serum fibroblast growth factor-23 (FGF-23) and other parameters of calcium-phosphate metabolism in DM and non-DM CKD patients. DESIGN AND SETTING: This was a prospective interventional study in a research center setting. PARTICIPANTS, INTERVENTION, AND MEASURES: Twenty-six nondialysis patients with stages 3-5 CKD and albuminuria less than 300 mg/g creatinine were recruited from February 2011 to November 2012 (15 DM, 11 non-DM). All patients received a high-phosphate diet (1800 mg/d) for 6 days. At baseline, day 3, and day 7 serum FGF-23, PTH, Ca, P, 25-hydroxyvitamin D, 1,25 dihydroxyvitamin D, monocyte chemoattractant protein-1, and calcium and phosphate urine excretion were measured. RESULTS: In DM CKD patients, serum calcium was lower on days 3 and 7 vs baseline (P < .01, respectively), and in non-DMpatients, it was unchanged. Serum phosphorus increased significantly only in non-DMpatients on days 3 and 7 vs baseline (P < 0.01, respectively). Serum PTH was higher in the DM group on day 7 vs baseline (P = .04). Plasma 25-hydroxyvitamin D, 1,25 dihydroxyvitamin D, and serum monocyte chemoattractant protein-1 were unchanged in both groups. Serum FGF-23 increased in DMpatients, from baseline to day 3 (58.1 ± 52.7 and 91.6 ± 71.1 pg/mL, P = .001) but later tended to decrease. In non-DMpatients, there was a steady increase of FGF-23 between baseline and day 7 (75 ± 84.3 to 176 ± 197 pg/mL, P = .04). Urine phosphate excretion was significantly higher on day 7 in DMpatients only (P < .05). CONCLUSIONS:PTH seems to play the major role in the regulation of phosphate excretion in DM CKD. The role of FGF-23 in phosphate disposal in DM CKD remains debatable.
Authors: Fiona N Byrne; Barbara A Gillman; Mairead Kiely; Brendan Palmer; Frances Shiely; Patricia M Kearney; Joyce Earlie; Maria B Bowles; Fiona M Keohane; Pauline P Connolly; Sarah Wade; Theresa A Rennick; Bernice L Moore; Oonagh N Smith; Celene M Sands; Orla Slevin; Denise C McCarthy; Karina M Brennan; Halóg Mellett; Darren Dahly; Eoin Bergin; Liam F Casserly; Peter J Conlon; Kieran Hannan; John Holian; David W Lappin; Yvonne M O'Meara; George J Mellotte; Donal Reddan; Alan Watson; Joseph Eustace Journal: Kidney Int Rep Date: 2020-08-18