Early Control of PTH and FGF23 in Normophosphatemic CKD Patients: A New Target in CKD-MBD Therapy?
Early Control of PTH and FGF23 in Normophosphatemic CKD Patients: A New Target in CKD-MBD Therapy?
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DOI：
10.2215/cjn.05420709
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发表时间：
2010-02-01
影响因子：
9.8
通讯作者：
Moyses, Rosa M. A.
中科院分区：
文献类型：
--
作者：
Oliveira, Rodrigo B.;Cancela, Ana L. E.;Moyses, Rosa M. A.
背景和目标：甲状旁腺激素（PTH）和磷酸尿激素FGF 23（成纤维细胞生长因子（FGF）家族成员）的水平在慢性肾病（CKD）发生高磷酸盐血症之前早期升高。这项为期6周的短期剂量滴定研究评估了两种磷结合剂对CKD 3 - 4期患者PTH和FGF 23水平的影响。设计、设置、参与者和测量：患者随机接受6周的醋酸钙（n = 19）或盐酸司维拉姆（n = 21）。基线时，患者的磷酸盐、血清PTH和FGF 23排泄分数升高。两种磷结合剂治疗期间，血清甲状旁腺激素和尿磷水平均逐渐下降，但血清钙和血清磷水平无变化。显着的变化，观察FGF 23只在司维拉姆治疗patients.Conclusions：这项研究证实了PTH控制的磷结合剂的早期处方的积极影响。前瞻性和长期研究是必要的，以确认司维拉姆对血清FGF 23的影响，以及这种降低对结局的益处。Clin J Am Soc Nephrol 5：286-291，2010. doi：10.2215/CJN.05420709
Background and objectives: Levels of parathyroid hormone (PTH) and the phosphaturic hormone FGF23, a fibroblast growth factor (FGF) family member, increase early in chronic kidney disease (CKD) before the occurrence of hyperphosphatemia. This short-term 6-wk dose titration study evaluated the effect of two phosphate binders on PTH and FGF23 levels in patients with CKD stages 3 to 4.Design, setting, participants, and measurements: Patients were randomized to receive over a 6-wk period either calcium acetate (n = 19) or sevelamer hydrochloride (n = 21).Results: At baseline, patients presented with elevated fractional excretion of phosphate, serum PTH, and FGF23. During treatment with both phosphate binders there was a progressive decline in serum PTH and urinary phosphate, but no change in serum calcium or serum phosphate. Significant changes were observed for FGF23 only in sevelamer-treated patients.Conclusions: This study confirms the positive effects of early prescription of phosphate binders on PTH control. Prospective and long-term studies are necessary to confirm the effects of sevelamer on serum FGF23 and the benefits of this decrease on outcomes. Clin J Am Soc Nephrol 5: 286-291, 2010. doi: 10.2215/CJN.05420709