Wan-Chuan Tsai1,2,3, Hon-Yen Wu1,2,4,5, Yu-Sen Peng1,4,5, Shih-Ping Hsu1,4, Yen-Ling Chiu1,4, Hung-Yuan Chen1,4, Ju-Yeh Yang1,4, Mei-Ju Ko6,7, Mei-Fen Pai1,4, Yu-Kang Tu2, Kuan-Yu Hung4,8, Kuo-Liong Chien2,4. 1. Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan. 2. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan. 3. Oriental Institute of Technology, New Taipei City, Taiwan. 4. Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan. 5. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan. 6. Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan. 7. Department of Dermatology, Taipei City Hospital, Taipei City, Taiwan. 8. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan.
Abstract
Background: Elevated fibroblast growth factor-23 (FGF23) levels increase the risk of cardiovascular diseases in patients with chronic kidney disease (CKD). We aimed to compare the effects of different dietary interventions, lower versus higher phosphate levels, on FGF23 in patients with CKD. Methods: We conducted electronic literature searches of Medline, PubMed, Embase and the Cochrane Library for publications up to 29 October 2016 for randomized clinical trials that compared lower versus higher phosphate dietary interventions in adults with CKD. The primary outcome was the difference in change-from-baseline FGF23 levels between intervention groups. Considering the difference in measurement units between intact FGF23 and C-terminal FGF23 assays, the treatment effect was analysed as the standardized mean difference (SMD) with the 95% confidence interval (CI). Results: We identified five trials enrolling a total of 94 normophosphataemic patients with Stage 3B CKD. The study duration ranged from 1 to 12 weeks. Compared with higher phosphate diets, lower phosphate diets tended to reduce FGF23 levels (SMD -0.74, 95% CI -1.54 to 0.07, P = 0.07). Subgroup analyses showed a trend (P for interaction = 0.09) towards a better FGF23-lowering effect by lower phosphate diets in studies using the intact FGF23 assay (SMD -1.14, 95% CI -2.24 to -0.04) than those using the C-terminal FGF23 assay (SMD -0.05, 95% CI -0.67 to 0.57). Conclusions: Short-term dietary phosphate restriction tends to reduce FGF23 levels in patients with moderately decreased kidney function, and the FGF23-lowering effects tend to be more prominent when measured with the intact FGF23 assay.
Background: Elevated fibroblast growth factor-23 (FGF23) levels increase the risk of cardiovascular diseases in patients with chronic kidney disease (CKD). We aimed to compare the effects of different dietary interventions, lower versus higher phosphate levels, on FGF23 in patients with CKD. Methods: We conducted electronic literature searches of Medline, PubMed, Embase and the Cochrane Library for publications up to 29 October 2016 for randomized clinical trials that compared lower versus higher phosphate dietary interventions in adults with CKD. The primary outcome was the difference in change-from-baseline FGF23 levels between intervention groups. Considering the difference in measurement units between intact FGF23 and C-terminal FGF23 assays, the treatment effect was analysed as the standardized mean difference (SMD) with the 95% confidence interval (CI). Results: We identified five trials enrolling a total of 94 normophosphataemic patients with Stage 3B CKD. The study duration ranged from 1 to 12 weeks. Compared with higher phosphate diets, lower phosphate diets tended to reduce FGF23 levels (SMD -0.74, 95% CI -1.54 to 0.07, P = 0.07). Subgroup analyses showed a trend (P for interaction = 0.09) towards a better FGF23-lowering effect by lower phosphate diets in studies using the intact FGF23 assay (SMD -1.14, 95% CI -2.24 to -0.04) than those using the C-terminal FGF23 assay (SMD -0.05, 95% CI -0.67 to 0.57). Conclusions: Short-term dietary phosphate restriction tends to reduce FGF23 levels in patients with moderately decreased kidney function, and the FGF23-lowering effects tend to be more prominent when measured with the intact FGF23 assay.
Authors: Cristian Rodelo-Haad; Rafael Santamaria; Juan R Muñoz-Castañeda; M Victoria Pendón-Ruiz de Mier; Alejandro Martin-Malo; Mariano Rodriguez Journal: Toxins (Basel) Date: 2019-03-22 Impact factor: 4.546
Authors: Thomas Ebert; Sven-Christian Pawelzik; Anna Witasp; Samsul Arefin; Sam Hobson; Karolina Kublickiene; Paul G Shiels; Magnus Bäck; Peter Stenvinkel Journal: Toxins (Basel) Date: 2020-04-04 Impact factor: 4.546