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High serum phosphorus and FGF 23 levels are associated with progression of coronary calcifications
Poyyapakkam R Srivaths1, Stuart L Goldstein, Rajesh Krishnamurthy
1Texas Children's Hospital-Pediatric Nephrology, Baylor College of Medicine, 6621 Fannin Street, MC 3-2482, Houston, TX, 77030, USA, srivaths@bcm.edu.
Insights
Coronary calcifications (CC) progress in pediatric hemodialysis (HD) patients. Higher serum phosphorus and FGF 23 levels are linked to this worsening CC progression.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Chronic Disease
- Biomarkers of Calcification
Background:
- Coronary calcifications (CC) are linked to mortality in adult hemodialysis (HD) patients.
- Risk factors for CC progression in pediatric HD patients are not well understood.
- Previous studies showed high CC prevalence (31%) in pediatric patients, associated with high phosphorus, FGF23, and low cholesterol.
Purpose of the Study:
- To determine and elucidate the progression of coronary calcifications (CC) in pediatric patients undergoing chronic hemodialysis (HD).
- To identify risk factors associated with CC progression in this vulnerable population.
Main Methods:
- A 1-year prospective longitudinal study.
- Involved 16 pediatric patients (mean age 16.9 ± 3 years) on chronic HD.
- Baseline and 1-year computed tomogram (CT) scans were used to assess CC, alongside serum phosphorus and FGF23 levels.
Main Results:
- 31.3% of patients had CC at baseline.
- All patients (3/5) with initial CC showed progression over 1 year; one patient developed new CC.
- CC progression was associated with higher serum phosphorus (8.6 ± 1.8 mg/dl vs. 6.3 ± 1.1 mg/dl) and FGF23 levels (3,994 ± 860.5 pg/ml vs. 2,327 ± 1,206.4 pg/ml).
- Serum phosphorus and FGF23 levels positively correlated with Agatston scores and change in scores.
Conclusions:
- Coronary calcifications (CC) are progressive in pediatric patients receiving hemodialysis (HD).
- Elevated serum phosphorus and FGF23 levels are significantly associated with CC progression in this cohort.
- These findings highlight the need for monitoring and potentially managing phosphorus and FGF23 in pediatric HD patients to mitigate CC progression.
Background:
Coronary calcifications (CC) portend increased mortality in adults receiving hemodialysis (HD), however the risk factors associated with CC progression are not well known in pediatric patients. Our previous cross-sectional studies demonstrated high CC prevalence (31 %) in pediatric patients, which were significantly associated with high serum phosphorus (P), fibroblast growth factor 23 (FGF) levels, dialysis vintage, and low cholesterol. The current study was undertaken to determine and elucidate CC progression in pediatric HD patients.
Methods:
A 1-year prospective longitudinal study of 16 pediatric patients (ten male; mean age, 16.9 ± 3 years; range, 10.1-20.4 years) receiving chronic HD was conducted.
Results:
CC were observed in five of 16 (31.3 %) patients on baseline computed tomogram (CT) scan; 14/16 patients underwent 1-year CT. All patients with initial CC who completed CT at 1 year (3/5) progressed; one patient had new CC and none of the patients had resolved CC. Mean Agatston score increased from 23.4 ± 18.06 HU (baseline) to 169 ± 298.9 HU. Patients with CC progression had higher mean serum P (8.6 ± 1.8 mg/dl vs. 6.3 ± 1.1 mg/dl, p = 0.015) and FGF 23 levels (3,994 ± 860.5 pg/ml vs. 2,327 ± 1,206.4 pg/ml, p = 0.028). Serum P and FGF 23 levels were positively correlated with final Agatston scores (R = 0.65, p = 0.01 for serum P and R = 0.54, p = 0.045 for FGF 23) and change in Agatston scores (R = 0.65, p = 0.01 for serum P and R = 0.52, p = 0.048 for FGF 23).
Conclusions:
Our study shows that CC is progressive in pediatric patients receiving HD and that increased serum P and FGF 23 levels are associated with this progression.
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