Changes in fibroblast growth factor 23 during treatment of secondary hyperparathyroidism with alfacalcidol or paricalcitol
Changes in fibroblast growth factor 23 during treatment of secondary hyperparathyroidism with alfacalcidol or paricalcitol
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DOI：
10.1093/ndt/gfr668
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发表时间：
2012-06-01
影响因子：
6.1
通讯作者：
Brandi, Lisbet
中科院分区：
文献类型：
--
作者：
Hansen, Ditte;Rasmussen, Knud;Brandi, Lisbet
背景资料。成纤维细胞生长因子23(FGF23)增加肾脏磷酸盐排泄，减少1，25-二羟基维生素D的形成。在慢性肾脏疾病患者中，血浆FGF23水平显著升高，机制不明。目的探讨阿法骨化醇和甲状旁腺素治疗血液透析患者继发性甲状旁腺功能亢进(SHPT)过程中FGF23的变化。采用随机、2周、3周、16周、治疗前6周和治疗间隔6周的交叉试验，比较阿法骨化醇和帕利骨化醇对血液透析SHPT患者的疗效。57例入选患者在每个疗程前、后各取血标本进行FGF23测定。两种类似物治疗均可增加FGF23(在所有治疗期间P<；0.05)。阿法骨化醇和甲骨化醇的增加幅度相似(周期1：223vs314%；P=0.384；周期2：174vs227%；P=0.510)，在冲洗期恢复到治疗前的水平。FGF23升高的独立预测因素是基线水平(P<；0.01)、离子钙(P<；0.01)和磷酸盐(P<；0.01)的变化以及维生素D类似物的累积剂量(P=0.024)。阿法骨化醇和帕利骨化醇均可显著提高血液透析患者血浆FGF23水平。
Background. Fibroblast growth factor 23 (FGF23) increases renal phosphate excretion and decreases the formation of 1,25 dihydroxyvitamin D. In patients with chronic kidney disease, plasma FGF23 levels are markedly elevated by unknown mechanisms. We explored the changes in FGF23 during treatment of secondary hyperparathyroidism (SHPT) with alfacalcidol or paricalcitol in haemodialysis patients.Methods. Intravenous alfacalcidol and paricalcitol were compared in haemodialysis patients with SHPT in a randomized 2 3 16-week cross-over study, with 6 weeks washout period preceding treatment and between treatment periods. In 57 of the enrolled patients, blood samples were frozen before and after each treatment period and available for measurement of FGF23.Results. Treatment with both analogues increased FGF23 (P < 0.05 in all treatment periods). The magnitude of increase was similar for alfacalcidol and paricalcitol (Period 1: 223 versus 314%; P = 0.384 and Period 2: 174 versus 227%; P = 0.510) and the levels returned to pre-treatment levels during the washout period. Independent predictors of rise in FGF23 were baseline levels of FGF23 (P < 0.01), changes in ionized calcium (P < 0.01) and phosphate (P < 0.01) and cumulative dose of vitamin D analogues (P = 0.024).Conclusion. Alfacalcidol and paricalcitol increase the plasma levels of FGF23 equally and substantially in haemodialysis patients.