ORIGINAL ARTICLE

The correlation between serum fibroblast growth factor-23 with urinary fractional excretion of phosphate in predialysis chronic kidney disease

Yenny Kandarini , Vika Wirdhani, Anak Agung Wira Dewi Lestari

Yenny Kandarini
Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Denpasar, Bali, Indonesia. Email: [email protected]

Vika Wirdhani
Department of Internal Medicine, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Denpasar, Bali, Indonesia

Anak Agung Wira Dewi Lestari
Department of Clinical Pathology, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Denpasar, Bali, Indonesia
Online First: December 01, 2020 | Cite this Article
Kandarini, Y., Wirdhani, V., Lestari, A. 2020. The correlation between serum fibroblast growth factor-23 with urinary fractional excretion of phosphate in predialysis chronic kidney disease. Bali Medical Journal 9(3): 884-887. DOI:10.15562/bmj.v9i3.1874


Purpose: To investigate the correlation of serum fibroblast growth factor-23 (FGF-23) with urinary fractional excretion of phosphate (FEPi) in predialysis chronic kidney disease (CKD).

Methods: This cross-sectional study involved 75 patients with CKD stage 2-4. Blood and 24-hour urine samples were taken from eligible participants to measure key variables using standard commercial assays. FGF-23 concentration was measured using enzyme-linked immunosorbent assay (ELISA). The correlation between FGF-23 serum level and urinary FEPi was analyzed using the Spearman correlation test.

Results: Of 75 eligible subjects, the majority had the characteristics of male gender, CKD stage 3, with mean age and body mass index of 50±10.8 and 23.51±3.3, respectively. The median FGF-23 level was 108.7 (13.6-1226.2) RU/ml, while the median urinary FEPi was 24.3% (4.04%-65.9%). There was a moderate positive correlation between FGF-23 and FEPi (r = 0.44, p<0.001).

Conclusion: The result confirmed the correlation between serum FGF-23 level with urinary FEPi in predialysis CKD.

References

Kuro-o M. A phosphate-centric paradigm for pathophysiology and therapy of chronic kidney disease. Kidney International Supplements. 2013;3:420-426.

Wahl P, Wolf M. FGF23 in Chronic Kidney Disease. In: Makoto Kuro-o, editor. Endocrine FGFs and Klothos. Landes Bioscience and Springer Science:2012. p.102-125.

Wolf M. Update on fibroblast gowth factor 23 in chronic kidney disease. Kidney Int. 2012;82(7):737-747.

Bagnis CI, Karie S, Deray G, Essig M. Hypohosphatemia: an easy strategy for diagnosis and treatment in HIV patients. International Medical Press. 2009;14:481-488.

Guitierrez O, Isakova T, Rhee E, Shah A, Holmes J, Collerone G. Fibroblast growth factor-23 mitigates hyperhosphatemia but accentuates calcitriol deficiency. Clin J Am Soc Nephrol. 2005;7:581-587.

Isakova T. Fibroblast Growth Factor 23 and Adverse Clinical Outcomes in Chronic Kidney Disease. Curr Opin Nephrol Hipertens. 2012;21(3):334-340.

Kestenbaum B, Drueke TB. Disorders of Calcium, phosphate, and magnesium metabolism. In : Floege J, Johnson RJ, Feehally J, editors. Comprehensive Clinical Nephrology 4th ed. Missouri: Saunders; 2010. p.969-983.

Lang F, Leibrock C, Pandyra AA, Stournaras C, Wagner CA, Föller M. Phosphate Homeostasis, Inflammation and the Regulation of FGF-23. Kidney Blood Press Res. 2018;43(6):1742-1748.

Isakova T, Wahl P, Vargas G, Gutierrez OM, Scialla J, Huiliang X. FGF23, PTH and phosphorus metabolism in the chronic renal insufficiency kohort. Kindey Int. 2011;79(12):1370-1378.

Heine GH, Seiler S, Fliser D. FGF-23: the Rise of a novel cardiovascular risk in CKD. Nephrol Dial Transplant. 2012; 27:3072-3081.

Bech AP, Krijger AB, Zuilen AD, Bots ML, Jan AJG, Blankestjin PJ, et al. Impact of fractional phosphate excretion on the relation of FGF23 with outcome in CKD patients. J Nephrol. 2015; 28:477-484.

Sakan H, Nakatani K, Asai O, Imura A, Tanaka T, Yoshimoto S. Reduced Renal α-Klotho Expression in CKD patients and its Effect on Renal Phosphate Handling and Vitamin D Metabolism, PLOS ONE. 2014;9(1):1-9.

Bellasi A, Di Micco L, Russo D, et al. Fractional Excretion of Phosphate (FeP) Is Associated with End-Stage Renal Disease Patients with CKD 3b and 5. J Clin Med. 2019;8(7):1026.

Sánchez Fructuoso AI, Maestro ML, Pérez-Flores I, Valero R, Rafael S, Veganzones S, Calvo N, De la Orden V, De la Flor JC, Valga F, Vidaurreta M, Fernández-Pérez C, Barrientos A. Serum level of fibroblast growth factor 23 in maintenance renal transplant patients. Nephrol Dial Transplant. 2012 Nov;27(11):4227-35.

Isakova T, Xie H, Yang W, et al. Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. JAMA. 2011;305(23):2432-2439.

Tsai MH, Leu JG, Fang YW, Liou HH. High Fibroblast Growth Factor 23 Levels Associated With Low Hemoglobin Levels in Patients With Chronic Kidney Disease Stages 3 and 4. Medicine (Baltimore). 2016;95(11):e3049.

Chathoth S, Al-Mueilo S, Cyrus C, et al. Elevated Fibroblast Growth Factor 23 Concentration: Prediction of Mortality among Chronic Kidney Disease Patients. Cardiorenal Med. 2015;6(1):73-82.

Yuen SN, Kramer H, Luke A, et al. Fibroblast Growth Factor-23 (FGF-23) Levels Differ Across Populations by Degree of Industrialization. J Clin Endocrinol Metab. 2016;101(5):2246-2253.

Craver L, Dusso A, Martinez-Alonso M, Sarro F, Valdivielso JM, Fernandez E. A Low Fractional Excretion of Phosphate/FGF23 ratio is associated with Severe Abdominal Aortic Calcification Stage 3 and 4 Chronic Kidney Disease Patients. BMC Nephrology. 2013;221(14):1-12.

Houston J, Smith K, Isakova T, Sowden N, Wolf M, Gutierrez OM. Associations of dietary phosphorus intake, urinary phosphate excretion and fibroblast growth factor 23 with vascular stiffness in chronic kidney disease. J Ren Nutr. 2013;23(1):12-20.

Evenopoel P, Meijers B, Viane L, Bammens B, Claes K, Kuypers D, et al. Fibroblast growth factor-23 in early chronic kidney disease: additional support in favor of a phosphate-centric paradigm for the pathogenesis of secondary hyperparathyroidsm. Clin J Am Soc Nephrol. 2010;5:1268-1276.

Dominguez JR, Shlipak MG, Whooley MA, Joachim H. Fractional excretion of phosphorus Modifies the association between fibroblast growth factor-23 and outcomes. J Am Soc Nephrol. 2013; 24(4):647-654.


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