Fibroblast growth factor 23 and markers of mineral metabolism in individuals with preserved renal function

Dhayat, Nasser; Ackermann, Daniel; Pruijm, Menno; Ponte, Belen; Ehret, Georg; Guessous, Idris; Leichtle, Alexander Benedikt; Paccaud, Fred; Mohaupt, Markus; Fiedler, Martin; Devuyst, Olivier; Pechère-Bertschi, Antoinette; Burnier, Michel; Martin, Pierre-Yves; Bochud, Murielle; Vogt, Bruno; Fuster, Daniel Guido (2016). Fibroblast growth factor 23 and markers of mineral metabolism in individuals with preserved renal function. Kidney international, 90(3), pp. 648-657. Elsevier 10.1016/j.kint.2016.04.024

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Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that regulates phosphate homeostasis. Circulating FGF23 is elevated in chronic kidney disease (CKD) and independently associated with poor renal and cardiovascular outcomes and mortality. Because the study of FGF23 in individuals with normal renal function has received little attention, we examined in a large, population based study of 1128 participants the associations of FGF23 with markers of mineral metabolism and renal function. The median estimated glomerular filtration rate (eGFR) of the cohort was 105 ml/min per 1.73 m2, and the median plasma FGF23 was 78.5 RU/ml. FGF23 increased and plasma 1,25-dihydroxyvitamin D3 decreased significantly below an eGFR threshold of 102 and 99 ml/min per 1.73 m2, respectively. In contrast, plasma parathyroid hormone increased continuously with decreasing eGFR and was first significantly elevated at an eGFR of 126 ml/min per 1.73 m2. On multivariable analysis adjusting for sex, age, body mass index, and GFR, FGF23 was negatively associated with 1,25-dihydroxyvitamin D3, and urinary absolute and fractional calcium excretion but not with serum calcium or parathyroid hormone. We found a positive association of FGF23 with plasma phosphate, but no association with urinary absolute or fractional phosphate excretion and, unexpectedly, a positive association with tubular maximum phosphate reabsorption/GFR. Thus, in the absence of CKD, parathyroid hormone increases earlier than FGF23 when the eGFR decreases. The increase in FGF23 occurs at a higher eGFR threshold than previously reported and is closely associated with a decrease in 1,25-dihydroxyvitamin D3. We speculate that the main demonstrable effect of FGF23 in the setting of preserved renal function is suppression of 1,25-dihydroxyvitamin D3 rather than stimulation of renal phosphate excretion.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Biochemistry and Molecular Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Nephrologie / Hypertonie

UniBE Contributor:

Dhayat, Nasser; Ackermann, Daniel; Leichtle, Alexander Benedikt; Mohaupt, Markus; Fiedler, Martin; Vogt, Bruno and Fuster, Daniel Guido

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

1523-1755

Publisher:

Elsevier

Language:

English

Submitter:

Nasser Dhayat

Date Deposited:

26 Jul 2016 15:49

Last Modified:

21 Jun 2017 13:33

Publisher DOI:

10.1016/j.kint.2016.04.024

PubMed ID:

27370409

BORIS DOI:

10.7892/boris.84110

URI:

https://boris.unibe.ch/id/eprint/84110

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