Hyperphosphatemia with elevated serum PTH and FGF23, reduced 1,25(OH)(2)D and normal FGF7 concentrations characterize patients with CKD.
Hyperphosphatemia with elevated serum PTH and FGF23, reduced 1,25(OH)(2)D and normal FGF7 concentrations characterize patients with CKD.
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DOI：
10.1186/s12882-021-02311-3
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发表时间：
2021-03-30
期刊：
影响因子：
2.3
通讯作者：
Kumar R
中科院分区：
文献类型：
--
作者：
Kritmetapak K;Losbanos L;Berent TE;Ashrafzadeh-Kian SL;Algeciras-Schimnich A;Hines JM;Singh RJ;Kumar R
高磷血症可导致不良心血管结局，通常发生在晚期CKD中。成纤维细胞生长因子7（FGF 7）是一种磷酸尿性肽，其在体外和体内降低肾磷酸盐转运。血清FGF 7浓度在伴有低磷酸盐血症的高磷酸盐血症患者中降低，而在某些伴有肿瘤诱导的骨软化症的低磷酸盐血症患者中升高。然而，没有数据表明循环中的FGF 7浓度是否增加以补偿CKD患者的磷酸盐潴留。这是一项在85例估计肾小球滤过率（eGFR）不同的成人患者中进行的横断面研究。我们使用iFGF 7免疫测定法测量血清完整FGF 7（iFGF 7）浓度并确定其相关因素。探索eGFR与矿物质代谢生物标志物[磷酸盐、iFGF 7、iFGF 23、甲状旁腺激素（PTH）和1，25-二羟维生素D（1，25（OH）2D）]之间的关系。对于≥ 60（n = 31）、45-59（n = 16）、30-44（n = 11）、15-29（n = 15）和< 15 mL/min/1.73 m2（n = 12）的eGFR，iFGF 7浓度中位数（IQ 25 -75）为46.1（39.2-56.9）、43.1（39.0-51.5）、47.3（38.3-66.5）、47.7（37.7-55.8）和49.6（42.5-65.6）pg/mL（P = 0.62）。在eGFR < 33时观察到血清iFGF 23、PTH和磷酸盐的显著增加（95%CI，26.40-40.05），< 29（95% CI，22.51-35.36），且< 22 mL/min/1.73 m2（95%CI，19.25-25.51），而在eGFR < 52 mL/min/1.73 m2时观察到血清1，25（OH）2D显著降低（95%CI，42.57-61.43）。血清iFGF 7与磷酸盐、iFGF 23、PTH和1，25（OH）2D之间无显著相关性。在多变量分析中，体重指数（每增加5 kg/m2）与血清iFGF 7浓度的最高四分位数独立相关（OR，1.20; 95% CI，1.12-1.55）。在CKD的早期阶段，循环1，25（OH）2D的代偿性减少和循环iFGF 23和PTH的增加（但不是iFGF 7）促进血清磷酸盐浓度的正常化。其他循环磷酸尿肽是否会对CKD患者的磷酸盐潴留产生反应，值得进一步研究。
Hyperphosphatemia confers adverse cardiovascular outcomes, and commonly occurs in late-stage CKD. Fibroblast growth factor 7 (FGF7) is a phosphaturic peptide which decreases renal phosphate transport in vitro and in vivo. Serum FGF7 concentrations are reduced in hyperphosphatemic patients with hypophosphatasia and are elevated in some hypophosphatemic patients with tumor-induced osteomalacia. No data, however, are available on whether circulating FGF7 concentrations increase to compensate for phosphate retention in CKD patients. This was a cross-sectional study performed among 85 adult patients with varying estimated glomerular filtration rates (eGFR). We measured serum intact FGF7 (iFGF7) concentration using an iFGF7 immunoassay and determined its associated factors. Relationships between eGFR and mineral metabolism biomarkers [phosphate, iFGF7, iFGF23, parathyroid hormone (PTH), and 1,25-dihydroxyvitamin D (1,25(OH)2D)] were explored. For eGFRs of ≥ 60 (n = 31), 45–59 (n = 16), 30–44 (n = 11), 15–29 (n = 15), and < 15 mL/min/1.73 m2 (n = 12), median (IQ25-75) iFGF7 concentrations were 46.1 (39.2–56.9), 43.1 (39.0-51.5), 47.3 (38.3–66.5), 47.7 (37.7–55.8), and 49.6 (42.5–65.6) pg/mL, respectively (P = 0.62). Significant increases in serum iFGF23, PTH, and phosphate were observed at eGFRs of < 33 (95 % CI, 26.40-40.05), < 29 (95 % CI, 22.51–35.36), and < 22 mL/min/1.73 m2 (95 % CI, 19.25–25.51), respectively, while significant decreases in serum 1,25(OH)2D were observed at an eGFR of < 52 mL/min/1.73 m2 (95 % CI, 42.57–61.43). No significant correlation was found between serum iFGF7 and phosphate, iFGF23, PTH or 1,25(OH)2D. In multivariable analyses, body mass index (per 5 kg/m2 increase) was independently associated with the highest quartile of serum iFGF7 concentration (OR, 1.20; 95 % CI, 1.12–1.55). Compensatory decreases in circulating 1,25(OH)2D and increases in circulating iFGF23 and PTH, but not iFGF7, facilitate normalization of serum phosphate concentration in early stages of CKD. Whether other circulating phosphaturic peptides change in response to phosphate retention in CKD patients deserves further study.
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影响因子：
56.9
作者：
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