Single FGF-23 measurement and time-averaged plasma phosphate levels in hemodialysis patients.
Single FGF-23 measurement and time-averaged plasma phosphate levels in hemodialysis patients.
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DOI：
10.2215/cjn.13021212
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发表时间：
2013-10
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通讯作者：
Sarah Seiler;G. Lucisano;P. Ege;Lisa H. Fell;K. Rogacev;Anne Lerner-Gräber;M. Klingele;M. Ziegler;D. Fliser;G. Heine
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作者：
Sarah Seiler;G. Lucisano;P. Ege;Lisa H. Fell;K. Rogacev;Anne Lerner-Gräber;M. Klingele;M. Ziegler;D. Fliser;G. Heine
背景和目的血浆磷水平在个体内表现出相当大的变异性。磷酸化成纤维细胞生长因子23是血磷水平的中央调节因子，它被认为是一个比传统的CKD-矿物质和骨代谢紊乱参数更稳定的标志物。因此，成纤维细胞生长因子23被假设为反映CKD患者的时间平均血磷水平。设计、设置、参与者和测量来自门诊透析中心的40名患者在2011年11月和12月进行了为期4周的研究，连续测量血钙和血磷(每次透析前)以及C末端成纤维细胞生长因子23、甲状旁腺激素和碱性磷酸酶(每周一次)。对重复测定血浆成纤维细胞生长因子23与其他CKD矿物质和骨病标记物的个体内变异性进行了检验，并分析了单一血浆成纤维细胞生长因子23测定与时间平均血磷水平的相关性。结果与预期相反，成纤维细胞生长因子23的个体内变异(中位数变异系数=27%；四分位数范围=20-35)并不低于血磷(中位数变异系数=15%；四分位数范围=10-20)、甲状旁腺激素(中位数变异系数=24%；四分位数范围=15-39)、血浆钙(中位数变异系数=3%；四分位数范围=2-4)或碱性磷酸酶(中位数变异系数=5%；四分位数范围=3-10)。此外，4周后最后一次测定成纤维细胞生长因子23与时间平均血磷之间的相关性没有超过最后一次成纤维细胞生长因子23测定与单一血浆磷酸盐之间的相关性(r=0.67P<；0.001；r=0.76，P<；0.001)。结论令人惊讶的是，成纤维细胞生长因子23与时间平均血磷水平的关系并不比单一的血磷值更密切，而且它也没有显示出比其他CKD矿物质和骨病检测标记物更低的个体内变异性。因此，临床实践中不应将成纤维细胞生长因子23用作时间平均血磷水平的反映。
BACKGROUND AND OBJECTIVES Plasma phosphate levels display considerable intraindividual variability. The phosphatonin fibroblast growth factor 23 is a central regulator of plasma phosphate levels, and it has been postulated to be a more stable marker than conventional CKD-mineral and bone disorder parameters. Thus, fibroblast growth factor 23 has been hypothesized to reflect time-averaged plasma phosphate levels in CKD patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 40 patients from the outpatient dialysis center, serial measurements of plasma calcium and phosphate (before every dialysis session) as well as C-terminal fibroblast growth factor 23, parathyroid hormone, and alkaline phosphatase (one time weekly) were performed over a study period of 4 weeks in November and December of 2011. Intraindividual variability of repeated plasma fibroblast growth factor 23 measurements compared with other CKD-mineral and bone disorder markers was tested, and the association of a single plasma fibroblast growth factor 23 measurement with time-averaged plasma phosphate levels was analyzed. RESULTS Against expectations, intraindividual variability of fibroblast growth factor 23 (median coefficient of variation=27%; interquartile range=20-35) was not lower than variability of plasma phosphate (median coefficient of variation=15%; interquartile range=10-20), parathyroid hormone (median coefficient of variation=24%; interquartile range=15-39), plasma calcium (median coefficient of variation=3%; interquartile range=2-4), or alkaline phosphatase (median coefficient of variation=5%; interquartile range=3-10). Moreover, the correlation between the last fibroblast growth factor 23 measurement after 4 weeks and time-averaged plasma phosphate did not surpass the correlation between the last fibroblast growth factor 23 measurement and a single plasma phosphate value (r=0.67, P<0.001; r=0.76, P<0.001, respectively). CONCLUSIONS Surprisingly, fibroblast growth factor 23 was not more closely associated to time-averaged plasma phosphate levels than a single plasma phosphate value, and it did not show a lower intraindividual variability than other tested markers of CKD-mineral and bone disorder. Thus, fibroblast growth factor 23 should not be used in clinical practice as a reflector of time-averaged plasma phosphate levels.