Altynay Balmukhanova1, Kairat Kabulbayev1, Harika Alpay2, Assiya Kanatbayeva1, Aigul Balmukhanova3. 1. Department of Nephrology, Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan. 2. Division of Pediatric Nephrology, Marmara University, 34899 Pendik, Turkey. 3. Department of Science and Innovations, Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan.
Abstract
Background and objectives: Chronic kidney disease (CKD) in children is a complex medical and social issue around the world. One of the serious complications is mineral-bone disorder (CKD-MBD) which might determine the prognosis of patients and their quality of life. Fibroblast growth factor 23 (FGF-23) is a phosphaturic hormone which is involved in the pathogenesis of CKD-MBD. The purpose of the study was to determine what comes first in children with CKD: FGF-23 or phosphate. Materials and Methods: This cross-sectional study included 73 children aged 2-18 years with CKD stages 1-5. We measured FGF-23 and other bone markers in blood samples and studied their associations. Results: Early elevations of FGF-23 were identified in children with CKD stage 2 compared with stage 1 (1.6 (1.5-1.8) pmol/L versus 0.65 (0.22-1.08), p = 0.029). There were significant differences between the advanced stages of the disease. FGF-23 correlated with PTH (r = 0.807, p = 0.000) and phosphate (r = 0.473, p = 0.000). Our study revealed that the elevated level of FGF-23 went ahead hyperphosphatemia and elevated PTH. Thus, more than 50% of children with CKD stage 2 had the elevating level of serum FGF-23, and that index became increasing with the disease progression and it achieved 100% at the dialysis stage. The serum phosphate increased more slowly and only 70.6% of children with CKD stage 5 had the increased values. The PTH increase was more dynamic. Conclusions: FGF-23 is an essential biomarker, elevates long before other markers of bone metabolism (phosphate), and might represent a clinical course of disease.
Background and objectives: Chronic kidney disease (CKD) in children is a complex medical and social issue around the world. One of the serious complications is mineral-bone disorder (CKD-MBD) which might determine the prognosis of patients and their quality of life. Fibroblast growth factor 23 (FGF-23) is a phosphaturic hormone which is involved in the pathogenesis of CKD-MBD. The purpose of the study was to determine what comes first in children with CKD: FGF-23 or phosphate. Materials and Methods: This cross-sectional study included 73 children aged 2-18 years with CKD stages 1-5. We measured FGF-23 and other bone markers in blood samples and studied their associations. Results: Early elevations of FGF-23 were identified in children with CKD stage 2 compared with stage 1 (1.6 (1.5-1.8) pmol/L versus 0.65 (0.22-1.08), p = 0.029). There were significant differences between the advanced stages of the disease. FGF-23 correlated with PTH (r = 0.807, p = 0.000) and phosphate (r = 0.473, p = 0.000). Our study revealed that the elevated level of FGF-23 went ahead hyperphosphatemia and elevated PTH. Thus, more than 50% of children with CKD stage 2 had the elevating level of serum FGF-23, and that index became increasing with the disease progression and it achieved 100% at the dialysis stage. The serum phosphate increased more slowly and only 70.6% of children with CKD stage 5 had the increased values. The PTH increase was more dynamic. Conclusions: FGF-23 is an essential biomarker, elevates long before other markers of bone metabolism (phosphate), and might represent a clinical course of disease.
Entities:
Keywords:
fibroblast growth factor 23; hyperphosphatemia; mineral and bone disorder; parathyroid hormone; phosphate metabolism
Authors: Anthony A Portale; Myles Wolf; Harald Jüppner; Shari Messinger; Juhi Kumar; Katherine Wesseling-Perry; George J Schwartz; Susan L Furth; Bradley A Warady; Isidro B Salusky Journal: Clin J Am Soc Nephrol Date: 2013-12-05 Impact factor: 8.237
Authors: Manish D Sinha; Charles Turner; R N Dalton; Pernille Rasmussen; Simon Waller; Caroline J Booth; David J Goldsmith Journal: Nephrol Dial Transplant Date: 2012-04-23 Impact factor: 5.992