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Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients
BACKGROUND: Hyperphosphatemia is associated with increased mortality and cardiovascular morbidity of end-stage kidney failure (ESKF) patients. Managing serum phosphate in ESKF patients is challenging and mostly based on limiting intestinal phosphate absorption with low phosphate diets and phosphate...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539220/ https://www.ncbi.nlm.nih.gov/pubmed/37779856 http://dx.doi.org/10.1093/ckj/sfad040 |
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author | Egli-Spichtig, Daniela Hamid, Ahmad Kamal Arroyo, Eva Maria Pastor Ketteler, Markus Wiecek, Andrzej Rosenkranz, Alexander R Pasch, Andreas Lorenz, Horst Hellmann, Burkhard Karus, Michael Ammer, Richard Rubio-Aliaga, Isabel Wagner, Carsten A |
author_facet | Egli-Spichtig, Daniela Hamid, Ahmad Kamal Arroyo, Eva Maria Pastor Ketteler, Markus Wiecek, Andrzej Rosenkranz, Alexander R Pasch, Andreas Lorenz, Horst Hellmann, Burkhard Karus, Michael Ammer, Richard Rubio-Aliaga, Isabel Wagner, Carsten A |
author_sort | Egli-Spichtig, Daniela |
collection | PubMed |
description | BACKGROUND: Hyperphosphatemia is associated with increased mortality and cardiovascular morbidity of end-stage kidney failure (ESKF) patients. Managing serum phosphate in ESKF patients is challenging and mostly based on limiting intestinal phosphate absorption with low phosphate diets and phosphate binders (PB). In a multi-centric, double-blinded, placebo-controlled study cohort of maintenance hemodialysis patients with hyperphosphatemia, we demonstrated the efficacy of nicotinamide modified release (NAMR) formulation treatment in addition to standard PB therapy in decreasing serum phosphate. Here we aimed to assess the relationship between phosphate, FGF23, inflammation and iron metabolism in this cohort. METHODS: We measured the plasma concentrations of intact fibroblast growth factor 23 (iFGF23) and selected proinflammatory cytokines at baseline and Week 12 after initiating treatment. RESULTS: We observed a strong correlation between iFGF23 and cFGF23 (C-terminal fragment plus iFGF23). We identified iFGF23 as a better predictor of changes in serum phosphate induced by NAMR and PB treatment compared with cFGF23. Recursive partitioning revealed at baseline and Week 12, that iFGF23 and cFGF23 together with T50 propensity were the most important predictors of serum phosphate, whereas intact parathyroid hormone (iPTH) played a minor role in this model. Furthermore, we found serum phosphate and iPTH as the best predictors of iFGF23 and cFGF23. Sex, age, body mass index, and markers of inflammation and iron metabolism had only a minor impact in predicting FGF23. CONCLUSION: Lowering serum phosphate in ESKF patients may depend highly on iFGF23 which is correlated to cFGF23 levels. Serum phosphate was the most important predictor of plasma FGF23 in this ESKF cohort. |
format | Online Article Text |
id | pubmed-10539220 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-105392202023-09-30 Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients Egli-Spichtig, Daniela Hamid, Ahmad Kamal Arroyo, Eva Maria Pastor Ketteler, Markus Wiecek, Andrzej Rosenkranz, Alexander R Pasch, Andreas Lorenz, Horst Hellmann, Burkhard Karus, Michael Ammer, Richard Rubio-Aliaga, Isabel Wagner, Carsten A Clin Kidney J Original Article BACKGROUND: Hyperphosphatemia is associated with increased mortality and cardiovascular morbidity of end-stage kidney failure (ESKF) patients. Managing serum phosphate in ESKF patients is challenging and mostly based on limiting intestinal phosphate absorption with low phosphate diets and phosphate binders (PB). In a multi-centric, double-blinded, placebo-controlled study cohort of maintenance hemodialysis patients with hyperphosphatemia, we demonstrated the efficacy of nicotinamide modified release (NAMR) formulation treatment in addition to standard PB therapy in decreasing serum phosphate. Here we aimed to assess the relationship between phosphate, FGF23, inflammation and iron metabolism in this cohort. METHODS: We measured the plasma concentrations of intact fibroblast growth factor 23 (iFGF23) and selected proinflammatory cytokines at baseline and Week 12 after initiating treatment. RESULTS: We observed a strong correlation between iFGF23 and cFGF23 (C-terminal fragment plus iFGF23). We identified iFGF23 as a better predictor of changes in serum phosphate induced by NAMR and PB treatment compared with cFGF23. Recursive partitioning revealed at baseline and Week 12, that iFGF23 and cFGF23 together with T50 propensity were the most important predictors of serum phosphate, whereas intact parathyroid hormone (iPTH) played a minor role in this model. Furthermore, we found serum phosphate and iPTH as the best predictors of iFGF23 and cFGF23. Sex, age, body mass index, and markers of inflammation and iron metabolism had only a minor impact in predicting FGF23. CONCLUSION: Lowering serum phosphate in ESKF patients may depend highly on iFGF23 which is correlated to cFGF23 levels. Serum phosphate was the most important predictor of plasma FGF23 in this ESKF cohort. Oxford University Press 2023-03-10 /pmc/articles/PMC10539220/ /pubmed/37779856 http://dx.doi.org/10.1093/ckj/sfad040 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Article Egli-Spichtig, Daniela Hamid, Ahmad Kamal Arroyo, Eva Maria Pastor Ketteler, Markus Wiecek, Andrzej Rosenkranz, Alexander R Pasch, Andreas Lorenz, Horst Hellmann, Burkhard Karus, Michael Ammer, Richard Rubio-Aliaga, Isabel Wagner, Carsten A Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients |
title | Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients |
title_full | Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients |
title_fullStr | Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients |
title_full_unstemmed | Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients |
title_short | Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients |
title_sort | intact fgf23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539220/ https://www.ncbi.nlm.nih.gov/pubmed/37779856 http://dx.doi.org/10.1093/ckj/sfad040 |
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