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Role of fibroblast growth factor 23 (FGF23) in the metabolism of phosphorus and calcium immediately after kidney transplantation.
Transplant Proc. 2012 Nov; 44(9):2551-4.TP

Abstract

INTRODUCTION

Persistence of inappropriately high serum levels of fibroblast growth factor-23 (FGF23), a recently discovered phosphaturic hormone, has been reported to play an important role in the pathogenesis of posttransplant hypophosphatemia. The aim of the present study was to evaluate FGF23 in the early posttransplant period and study the complex associations between FGF23, parathyroid hormone (PTH), 1,25(OH)(2) vitamin D, and phosphate in transplant patients.

MATERIALS AND METHODS

We performed a cross-sectional observational study of 42 adult kidney recipients in the early posttransplant period (<6 months). Fasting serum samples and 24-hour urine samples were collected during a routine follow-up outpatient visit. Serum creatinine, calcium, phosphate, magnesium and urinary creatinine, calcium, magnesium, and phosphate were measured using standard assays. We also studied concentrations of 25 hydroxyvitamin D, 1,25(OH)(2) vitamin D, intact PTH, and circulating FGF23.

RESULTS

Median values for the different parameters studied were as follows: 9.9 ± 0.6 mg/dL, phosphatemia 3.3 ± 0.7 mg/dL, estimated glomerular filtration rate (eGFR; 41.1 ± 14.0 mL/min, phosphate reabsorption rate 68.4% ± 10.7%, PTH 94.5 ng/L (53.8-199.5), calcitriol 33.0 pg/mL (24.0-44.1), calcidiol 27.3 ng/mL (17.0-38.0), FGF23 139 pg/mL (88-221), and calciuria 62.5 mg/d (40.3-101.3). The variables significantly associated with serum FGF23 levels were phosphate reabsorption rate (r = .493; P = .001), calcitriol (r = .399; P = .009), eGFR (r = .557; P < .001), PTH (0.349; P = .024).

CONCLUSIONS

Elevated serum levels of FGF23 could explain the deficiency of calcitriol and elevated renal phosphorus wasting in the early posttransplant period. All treatments that can lead to increased serum phosphate levels (eg, oral medication or calcitriol) should be carefully evaluated, since increased phosphatemia could further stimulate secretion of FGF23 and prolong high phosphorus loss.

Authors+Show Affiliations

Nephrology Department, Hospital Clinico 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 available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23146451

Citation

Sánchez Fructuoso, A I., et al. "Role of Fibroblast Growth Factor 23 (FGF23) in the Metabolism of Phosphorus and Calcium Immediately After Kidney Transplantation." Transplantation Proceedings, vol. 44, no. 9, 2012, pp. 2551-4.
Sánchez Fructuoso AI, Maestro ML, Calvo N, et al. Role of fibroblast growth factor 23 (FGF23) in the metabolism of phosphorus and calcium immediately after kidney transplantation. Transplant Proc. 2012;44(9):2551-4.
Sánchez Fructuoso, A. I., Maestro, M. L., Calvo, N., De La Orden, V., Pérez Flores, I., Vidaurreta, M., Valero, R., Fernández-Pérez, C., & Barrientos, A. (2012). Role of fibroblast growth factor 23 (FGF23) in the metabolism of phosphorus and calcium immediately after kidney transplantation. Transplantation Proceedings, 44(9), 2551-4. https://doi.org/10.1016/j.transproceed.2012.09.070
Sánchez Fructuoso AI, et al. Role of Fibroblast Growth Factor 23 (FGF23) in the Metabolism of Phosphorus and Calcium Immediately After Kidney Transplantation. Transplant Proc. 2012;44(9):2551-4. PubMed PMID: 23146451.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of fibroblast growth factor 23 (FGF23) in the metabolism of phosphorus and calcium immediately after kidney transplantation. AU - Sánchez Fructuoso,A I, AU - Maestro,M L, AU - Calvo,N, AU - De La Orden,V, AU - Pérez Flores,I, AU - Vidaurreta,M, AU - Valero,R, AU - Fernández-Pérez,C, AU - Barrientos,A, PY - 2012/11/14/entrez PY - 2012/11/14/pubmed PY - 2013/6/14/medline SP - 2551 EP - 4 JF - Transplantation proceedings JO - Transplant Proc VL - 44 IS - 9 N2 - INTRODUCTION: Persistence of inappropriately high serum levels of fibroblast growth factor-23 (FGF23), a recently discovered phosphaturic hormone, has been reported to play an important role in the pathogenesis of posttransplant hypophosphatemia. The aim of the present study was to evaluate FGF23 in the early posttransplant period and study the complex associations between FGF23, parathyroid hormone (PTH), 1,25(OH)(2) vitamin D, and phosphate in transplant patients. MATERIALS AND METHODS: We performed a cross-sectional observational study of 42 adult kidney recipients in the early posttransplant period (<6 months). Fasting serum samples and 24-hour urine samples were collected during a routine follow-up outpatient visit. Serum creatinine, calcium, phosphate, magnesium and urinary creatinine, calcium, magnesium, and phosphate were measured using standard assays. We also studied concentrations of 25 hydroxyvitamin D, 1,25(OH)(2) vitamin D, intact PTH, and circulating FGF23. RESULTS: Median values for the different parameters studied were as follows: 9.9 ± 0.6 mg/dL, phosphatemia 3.3 ± 0.7 mg/dL, estimated glomerular filtration rate (eGFR; 41.1 ± 14.0 mL/min, phosphate reabsorption rate 68.4% ± 10.7%, PTH 94.5 ng/L (53.8-199.5), calcitriol 33.0 pg/mL (24.0-44.1), calcidiol 27.3 ng/mL (17.0-38.0), FGF23 139 pg/mL (88-221), and calciuria 62.5 mg/d (40.3-101.3). The variables significantly associated with serum FGF23 levels were phosphate reabsorption rate (r = .493; P = .001), calcitriol (r = .399; P = .009), eGFR (r = .557; P < .001), PTH (0.349; P = .024). CONCLUSIONS: Elevated serum levels of FGF23 could explain the deficiency of calcitriol and elevated renal phosphorus wasting in the early posttransplant period. All treatments that can lead to increased serum phosphate levels (eg, oral medication or calcitriol) should be carefully evaluated, since increased phosphatemia could further stimulate secretion of FGF23 and prolong high phosphorus loss. SN - 1873-2623 UR - https://www.unboundmedicine.com/medline/citation/23146451/Role_of_fibroblast_growth_factor_23__FGF23__in_the_metabolism_of_phosphorus_and_calcium_immediately_after_kidney_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(12)01052-4 DB - PRIME DP - Unbound Medicine ER -