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Serum level of fibroblast growth factor 23 in maintenance renal transplant patients.
Nephrol Dial Transplant. 2012 Nov; 27(11):4227-35.ND

Abstract

BACKGROUND

The discovery of fibroblast growth factor 23 (FGF23) provides a new conceptual framework that improves our understanding of the pathogenesis of post-transplant bone disease. Excess FGF23 is produced in the early post-transplant period; levels return to normal in the months following transplant. However, few manuscripts discuss FGF23 levels in stable long-term renal transplant recipients.

METHODS

We performed a cross-sectional observational study of 279 maintenance kidney recipients with chronic kidney disease (CKD) Stages 1-4 and stable allograft function who had received their transplant at least 12 months previously. We calculated the estimated GFR (eGFR) using the MDRD4 equation.

RESULTS

FGF23, parathyroid hormone (PTH) and phosphorus values were higher in more advanced stages, while the serum calcitriol levels and the phosphate reabsorption rate were lower. A significant inverse correlation was found between eGFR and FGF23 (r = -0.487; P < 0.001), PTH (r = -0.444; P < 0.001), serum phosphate levels (r = -0.315; P < 0.001) and fractional excretion of magnesium (r = -0.503; P < 0.001). Multivariable analysis showed that increased time on corticosteroids (P < 0.001), PTH (P < 0.001), serum phosphate (P = 0.003), decreased serum calcitriol (P = 0.049) and estimated glomerular filtration (P = 0.003) rate were associated with high FGF23 levels. In contrast with pre-transplant patients and first year post-transplant patients, higher FGF23 values were not correlated with increased phosphate excretion. An elevated phosphate reabsorption rate was associated with decreased PTH (P < 0.001) and calciuria (P = 0.028) and increased serum calcitriol (P = 0.009), plasma bicarbonate (P = 0.024) and estimated glomerular filtration (P = 0.003).

CONCLUSIONS

Serum FGF23 concentrations remain increased in long-term kidney graft recipients, even in the early stages of CKD. It remains to be seen whether measures aimed at reducing serum levels of PTH and phosphate and/or corticosteroid doses might help to lower serum FGF23 and whether this will improve kidney recipient outcomes.

Authors+Show Affiliations

Nephrology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain. sanchezfructuoso@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23144073

Citation

Sánchez Fructuoso, Ana I., et al. "Serum Level of Fibroblast Growth Factor 23 in Maintenance Renal Transplant Patients." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 27, no. 11, 2012, pp. 4227-35.
Sánchez Fructuoso AI, Maestro ML, Pérez-Flores I, et al. Serum level of fibroblast growth factor 23 in maintenance renal transplant patients. Nephrol Dial Transplant. 2012;27(11):4227-35.
Sánchez Fructuoso, A. I., Maestro, M. L., Pérez-Flores, I., Valero, R., Rafael, S., Veganzones, S., Calvo, N., De la Orden, V., De la Flor, J. C., Valga, F., Vidaurreta, M., Fernández-Pérez, C., & Barrientos, A. (2012). Serum level of fibroblast growth factor 23 in maintenance renal transplant patients. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 27(11), 4227-35. https://doi.org/10.1093/ndt/gfs409
Sánchez Fructuoso AI, et al. Serum Level of Fibroblast Growth Factor 23 in Maintenance Renal Transplant Patients. Nephrol Dial Transplant. 2012;27(11):4227-35. PubMed PMID: 23144073.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum level of fibroblast growth factor 23 in maintenance renal transplant patients. AU - Sánchez Fructuoso,Ana I, AU - Maestro,Maria L, AU - Pérez-Flores,Isabel, AU - Valero,Rosalía, AU - Rafael,Sara, AU - Veganzones,Silvia, AU - Calvo,Natividad, AU - De la Orden,Virginia, AU - De la Flor,Jose C, AU - Valga,Francisco, AU - Vidaurreta,Marta, AU - Fernández-Pérez,Cristina, AU - Barrientos,Alberto, PY - 2012/11/13/entrez PY - 2012/11/13/pubmed PY - 2013/6/29/medline SP - 4227 EP - 35 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 27 IS - 11 N2 - BACKGROUND: The discovery of fibroblast growth factor 23 (FGF23) provides a new conceptual framework that improves our understanding of the pathogenesis of post-transplant bone disease. Excess FGF23 is produced in the early post-transplant period; levels return to normal in the months following transplant. However, few manuscripts discuss FGF23 levels in stable long-term renal transplant recipients. METHODS: We performed a cross-sectional observational study of 279 maintenance kidney recipients with chronic kidney disease (CKD) Stages 1-4 and stable allograft function who had received their transplant at least 12 months previously. We calculated the estimated GFR (eGFR) using the MDRD4 equation. RESULTS: FGF23, parathyroid hormone (PTH) and phosphorus values were higher in more advanced stages, while the serum calcitriol levels and the phosphate reabsorption rate were lower. A significant inverse correlation was found between eGFR and FGF23 (r = -0.487; P < 0.001), PTH (r = -0.444; P < 0.001), serum phosphate levels (r = -0.315; P < 0.001) and fractional excretion of magnesium (r = -0.503; P < 0.001). Multivariable analysis showed that increased time on corticosteroids (P < 0.001), PTH (P < 0.001), serum phosphate (P = 0.003), decreased serum calcitriol (P = 0.049) and estimated glomerular filtration (P = 0.003) rate were associated with high FGF23 levels. In contrast with pre-transplant patients and first year post-transplant patients, higher FGF23 values were not correlated with increased phosphate excretion. An elevated phosphate reabsorption rate was associated with decreased PTH (P < 0.001) and calciuria (P = 0.028) and increased serum calcitriol (P = 0.009), plasma bicarbonate (P = 0.024) and estimated glomerular filtration (P = 0.003). CONCLUSIONS: Serum FGF23 concentrations remain increased in long-term kidney graft recipients, even in the early stages of CKD. It remains to be seen whether measures aimed at reducing serum levels of PTH and phosphate and/or corticosteroid doses might help to lower serum FGF23 and whether this will improve kidney recipient outcomes. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/23144073/Serum_level_of_fibroblast_growth_factor_23_in_maintenance_renal_transplant_patients_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfs409 DB - PRIME DP - Unbound Medicine ER -