FGF23, Albuminuria, and Disease Progression in Patients with Chronic IgA Nephropathy
FGF23, Albuminuria, and Disease Progression in Patients with Chronic IgA Nephropathy
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DOI：
10.2215/cjn.10331011
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发表时间：
2012-05-01
影响因子：
9.8
通讯作者：
Larsson, Tobias E.
中科院分区：
文献类型：
--
作者：
Lundberg, Sigrid;Qureshi, Abdul Rashid;Larsson, Tobias E.
背景与目的成纤维细胞生长因子23（FGF 23）调节矿物质代谢。循环中的FGF 23水平升高并可预测CKD的结局。然而，FGF 23与蛋白尿和CKD患者疾病进展的关系和一个潜在的diagnosis is unknown.Design，setting，participants，& measurements前瞻性，观察性研究，在180例伊加肾病（IgAN），CKD阶段1-4，和中位数55个月的后续（范围，12-177个月）。主要结局为（1）时间平均白蛋白尿，（2A）进展至CKD 5期或估计GFR损失>= 50%，（2B）进展至CKD 5期或10年内估计GFR损失>= 25%，结果FGF 23与基线和时间平均白蛋白尿独立相关（每增加log FGF 23，1 g/24小时白蛋白尿的变化：β = 0.26; P=0.02）。Log FGF 23在原始模型中和针对矿物质代谢物调整后预测CKD进展（终点2A和2B）。在校正了年龄、性别、血清白蛋白、钙、磷酸盐、甲状旁腺激素、25-羟基维生素D、基线白蛋白尿、基线估计GFR、平均动脉血压、体重指数和终点2B中血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用后，其仍具有显著性（风险比，2.53; P=0.02），而不是终点2A（风险比，2.01; P=0.43）。在同一模型中，log FGF 23预测GFR估计值的年损失（每增加1.73 m2，log FGF 23的ml/min变化为1.50; P=0.008）。结论在CKD和IgAN患者中，FGF 23与白蛋白尿和CKD进展相关，这一发现提示其作为IgAN潜在生物标志物的作用。Clin J Am Soc Nephrol 7：727-734，2012. doi：10.2215/CJN.10331011
Background and objectives Fibroblast growth factor-23 (FGF23) regulates mineral metabolism. Circulatory FGF23 levels are increased and predict outcomes in CKD. However, the relation of FGF23 to albuminuria and disease progression in patients with CKD and one underlying diagnosis is unknown.Design, setting, participants, & measurements Prospective, observational study in 180 patients with IgA nephropathy (IgAN), CKD stage 1-4, and median 55-month follow-up (range, 12-177 months). Primary outcomes were (1) time-averaged albuminuria, (2A) progression to CKD stage 5 or >= 50% loss of estimated GFR, (2B) progression to CKD stage 5 or >= 25% loss of estimated GFR within 10 years, and (3) annual loss of estimated GFR.Results FGF23 was independently associated with baseline and time-averaged albuminuria (change in 1 g/24 hour albuminuria per increase in log FGF23: beta = 0.26; P=0.02). Log FGF23 predicted CKD progression in crude models and after adjustment for mineral metabolites (endpoints 2A and 2B). It remained significant after adjustments for age, sex, serum albumin, calcium, phosphate, parathyroid hormone, 25-hydroxyvitamin D, baseline albuminuria, baseline estimated GFR, mean arterial BP, body mass index, and angiotensin-converting enzyme inhibitors/angiotensin-receptor blocker use in endpoint 2B (hazard ratio, 2.53; P=0.02) but not endpoint 2A (hazard ratio, 2.01; P=0.43). Log FGF23 predicted annual loss of estimated GFR in the same model (change in ml/min per 1.73 m(2) per increase in log FGF23, 1.50; P=0.008).Conclusions In patients with CKD and IgAN, FGF23 was associated with albuminuria and CKD progression, a finding that suggests its role as a potential biomarker in IgAN. Clin J Am Soc Nephrol 7: 727-734, 2012. doi: 10.2215/CJN.10331011