Fibroblast Growth Factor 23, but not Parathyroid Hormone, Is Associated With Urinary Phosphate Regulation in Patients on Peritoneal Dialysis
Fibroblast Growth Factor 23, but not Parathyroid Hormone, Is Associated With Urinary Phosphate Regulation in Patients on Peritoneal Dialysis
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DOI：
10.1111/1744-9987.12221
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发表时间：
2015-02
影响因子：
1.9
通讯作者：
S. Yamada;K. Tsuruya;M. Tokumoto;H. Yoshida;Shoko Hasegawa;Shigeru Tanaka;M. Eriguchi;T. Nakano;K. Masutani;H. Ooboshi;T. Kitazono
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作者：
S. Yamada;K. Tsuruya;M. Tokumoto;H. Yoshida;Shoko Hasegawa;Shigeru Tanaka;M. Eriguchi;T. Nakano;K. Masutani;H. Ooboshi;T. Kitazono
成纤维细胞生长因子（FGF） 23在慢性肾病患者肾脏磷酸盐排泄调节中起重要作用。然而，FGF23是否与低肾小球滤过率（GFR）患者的肾磷酸盐处理密切相关仍不确定。本横断面研究包括52例接受腹膜透析的门诊患者，尿量≥100ml /天。主要结局是尿磷酸盐排泄水平，次要结局是归一化的肾小管最大磷酸盐重吸收GFR (TmP/GFR)，一个肾脏磷酸盐排泄阈值指标，以及腹膜磷酸盐排泄水平。感兴趣的变量是血清FGF23和甲状旁腺激素（PTH）水平。血清FGF23水平、TmP/GFR、尿液和腹膜总磷酸盐排泄的中位数和四分位数范围分别为5610 (1493 - 1130)ng/mL、1.30 (0.44-1.86)mg/dL、117 (40-234)mg/day和208 (156-250)mg/day。多因素线性回归分析显示，在调整混杂因素后，血清FGF23水平与TmP/GFR呈显著（P < 0.05）负相关，与尿磷酸盐排泄呈显著（P < 0.05）正相关。相比之下，三个结果变量均与血清甲状旁腺激素水平无关。血清FGF23和甲状旁腺激素水平均与腹膜磷酸盐排泄无关。本研究表明，FGF23参与尿磷调节，而非PTH，即使在有残余肾功能的腹膜透析患者中也是如此。
Fibroblast growth factor (FGF) 23 plays an important role in regulation of renal phosphate excretion in patients with chronic kidney disease. However, it remains undetermined whether FGF23 is closely linked to renal phosphate handling in patients with low glomerular filtration rate (GFR). The present cross‐sectional study included 52 outpatients undergoing peritoneal dialysis with urine volume ≥ 100 mL/day. The primary outcome was level of urinary phosphate excretion, and the secondary outcomes were tubular maximal reabsorption of phosphate normalized to GFR (TmP/GFR), an index of the renal threshold for phosphate excretion, and level of peritoneal phosphate excretion. Variates of interest were serum FGF23 and parathyroid hormone (PTH) levels. The median and interquartile range of serum FGF23 level, TmP/GFR, and total urinary and peritoneal phosphate excretion were 5610 (1493–11 430) ng/mL, 1.30 (0.44–1.86) mg/dL, 117 (40–234) mg/day, and 208 (156–250) mg/day, respectively. Multivariate linear regression analysis revealed that serum FGF23 level was significantly (P < 0.05) associated with TmP/GFR negatively and significantly (P < 0.05) associated with urinary phosphate excretion positively, even after adjusting for confounders. In contrast, none of the three outcome variates was associated with serum PTH level. Neither serum FGF23 nor PTH level was associated with peritoneal phosphate excretion. The present study indicates that FGF23, but not PTH, is involved in urinary phosphate regulation, even in patients on peritoneal dialysis with residual renal function.