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Impaired GFR is the most important determinant for FGF-23 increase in chronic kidney disease
Guido Filler1, Daisy Liu, Shih-Han Susan Huang
1Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada N6A 5W9. guido.filler@lhsc.on.ca
Objectives:
It is unclear whether fibroblast growth factor-23 (FGF-23) increases in response to phosphate accumulation or to decrease clearance in chronic kidney disease (CKD) as is the case with other low molecular weight proteins such as cystatin C (CysC).
Design And Methods:
This cross-sectional study measured serum FGF-23, CysC, and other serum markers of bone metabolism in 69 patients, aged 18 months-24 years, with various stages of CKD (eGFR=11-214mL/min).
Results:
FGF-23 levels were significantly correlated with CysC and parathyroid hormone levels (PTH) on univariate non-linear regression analysis. In multivariate linear regression analysis, log (CysC) (β=0.660, p<0.0001), log (PTH) (β=0.038, p=0.37), and phosphate (β=0.222, p=0.028) explained 69.1% of the variance of FGF-23.
Conclusions:
CysC had the largest unique contribution to FGF-23 variance in this model, supporting the hypothesis that renal clearance may be the most responsible factor for elevated FGF-23 levels in early stages of CKD.
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