Kullaya Takkavatakarn1, Thunyatorn Wuttiputhanun1, Jeerath Phannajit1, Kearkiat Praditpornsilpa1, Somchai Eiam-Ong1, Paweena Susantitaphong2,3. 1. Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 RAMA IV, Bangkok, 10330, Thailand. 2. Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 RAMA IV, Bangkok, 10330, Thailand. pesancerinus@hotmail.com. 3. Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. pesancerinus@hotmail.com.
Abstract
INTRODUCTION: The heightened fibroblast growth factor 23 (FGF23) level in patients with chronic kidney disease (CKD) is associated with increased cardiovascular disease and mortality. We performed a systematic review and meta-analysis to synthesize the available strategies to reduce FGF23 in CKD patients. METHODS: We conducted a meta-analysis by searching the databases of MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) and single-arm studies that examined the effects of dietary phosphate restriction, phosphate binders, iron supplements, calcimimetics, parathyroidectomy, dialysis techniques, and the outcome of preservation of residual renal function (RRF) on FGF23 levels in CKD patients. Random-effects model meta-analyses were used to compute changes in the outcome of interests. RESULTS: A total of 41 articles (7590 patients), comprising 36 RCTs, 5 prospective studies were included in this meta-analysis. Dietary phosphate restriction less than 800 mg per day yielded insignificant effect on FGF23 reduction. Interestingly sevelamer, lanthanum, iron-based phosphate binders, and iron supplement significantly lowered FGF23 levels. In CKD patients with secondary hyperparathyroidism, calcimimetics prescription could significantly reduce FGF23 levels, while surgical parathyroidectomy had no significant effect. In dialysis patients, preservation of RRF and hemoperfusion as well as hemodiafiltration provided a significant decrease in FGF23 levels. CONCLUSIONS: The present meta-analysis demonstrated that non-calcium-based phosphate binders including sevelamer, lanthanum, and iron-based phosphate binders, iron supplements, calcimimetics, hemoperfusion, and preservation of RRF could effectively reduce FGF23 in CKD patients.
INTRODUCTION: The heightened fibroblast growth factor 23 (FGF23) level in patients with chronic kidney disease (CKD) is associated with increased cardiovascular disease and mortality. We performed a systematic review and meta-analysis to synthesize the available strategies to reduce FGF23 in CKD patients. METHODS: We conducted a meta-analysis by searching the databases of MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) and single-arm studies that examined the effects of dietary phosphate restriction, phosphate binders, iron supplements, calcimimetics, parathyroidectomy, dialysis techniques, and the outcome of preservation of residual renal function (RRF) on FGF23 levels in CKD patients. Random-effects model meta-analyses were used to compute changes in the outcome of interests. RESULTS: A total of 41 articles (7590 patients), comprising 36 RCTs, 5 prospective studies were included in this meta-analysis. Dietary phosphate restriction less than 800 mg per day yielded insignificant effect on FGF23 reduction. Interestingly sevelamer, lanthanum, iron-based phosphate binders, and iron supplement significantly lowered FGF23 levels. In CKD patients with secondary hyperparathyroidism, calcimimetics prescription could significantly reduce FGF23 levels, while surgical parathyroidectomy had no significant effect. In dialysis patients, preservation of RRF and hemoperfusion as well as hemodiafiltration provided a significant decrease in FGF23 levels. CONCLUSIONS: The present meta-analysis demonstrated that non-calcium-based phosphate binders including sevelamer, lanthanum, and iron-based phosphate binders, iron supplements, calcimimetics, hemoperfusion, and preservation of RRF could effectively reduce FGF23 in CKD patients.
Authors: Jair Munoz Mendoza; Tamara Isakova; Xuan Cai; Liz Y Bayes; Christian Faul; Julia J Scialla; James P Lash; Jing Chen; Jiang He; Sankar Navaneethan; Lavinia Negrea; Sylvia E Rosas; Matthias Kretzler; Lisa Nessel; Dawei Xie; Amanda Hyre Anderson; Dominic S Raj; Myles Wolf Journal: Kidney Int Date: 2016-12-22 Impact factor: 10.612
Authors: Tamara Isakova; Patricia Wahl; Gabriela S Vargas; Orlando M Gutiérrez; Julia Scialla; Huiliang Xie; Dina Appleby; Lisa Nessel; Keith Bellovich; Jing Chen; Lee Hamm; Crystal Gadegbeku; Edward Horwitz; Raymond R Townsend; Cheryl A M Anderson; James P Lash; Chi-Yuan Hsu; Mary B Leonard; Myles Wolf Journal: Kidney Int Date: 2011-03-09 Impact factor: 10.612
Authors: Annet Bouma-de Krijger; Camiel L M de Roij van Zuijdewijn; Menso J Nubé; Muriel P C Grooteman; Marc G Vervloet Journal: Clin Kidney J Date: 2020-04-01
Authors: Robin Haring; Danielle Enserro; Vanessa Xanthakis; Gary F Mitchell; Emelia J Benjamin; Naomi M Hamburg; Lisa Sullivan; Matthias Nauck; Henri Wallaschofski; Ramachandran S Vasan Journal: J Am Heart Assoc Date: 2016-07-06 Impact factor: 5.501