Anemia and Mineral Bone Disorder in Kidney Disease Patients: The Role of FGF-23 and Other Related Factors
Nazareno Carullo1, David Sorbo2, Teresa Faga3
1"G. Jazzolino" Hospital, A.S.P. Vibo Valentia, I89900 Vibo Valentia, Italy.
Insights
Anemia and mineral and bone disorder (MBD) in chronic kidney disease (CKD) involve erythropoietin (Epo) and fibroblast growth factor-23 (FGF-23). Their complex interactions, alongside factors like Klotho and iron, form a "kidney-bone marrow-bone axis" driving CKD-MBD.
Area of Science:
- Nephrology
- Endocrinology
- Bone Biology
Background:
- Anemia and mineral and bone disorder (MBD) are common complications of chronic kidney disease (CKD).
- The erythropoietin (Epo) pathway and fibroblast growth factor-23 (FGF-23) are key molecules involved in CKD pathogenesis.
- FGF-23 regulates phosphate homeostasis via Klotho but also impacts anemia and inflammation in CKD.
Purpose of the Study:
- To review the regulation and molecular mechanisms of Epo and FGF-23 in CKD.
- To explore the intricate interplay between Epo and FGF-23.
- To discuss their association with other anemia-related factors in CKD-MBD.
Main Methods:
- Literature review focusing on Epo and FGF-23 pathways.
- Analysis of molecular mechanisms underlying their actions in CKD.
- Synthesis of evidence on interactions with Klotho, vitamin D, and iron deficiency.
Main Results:
- Epo and FGF-23 exhibit complex regulatory networks in CKD.
- Their actions are intertwined with Klotho, vitamin D, and iron status.
- These factors contribute to a unified
- kidney-bone marrow-bone axis
- promoting CKD-MBD.
Conclusions:
- Epo and FGF-23 are central to understanding CKD complications.
- The identified axis provides a framework for novel therapeutic strategies.
- Further research into these interactions is crucial for managing CKD-MBD.
Abstract:
Anemia and mineral and bone disorder (MBD) are significant complications of chronic kidney disease (CKD). The erythropoietin (Epo) pathway plays a key role in both of these processes in CKD. Another molecule that plays an important role in CKD-MBD is fibroblast growth factor (FGF)-23, whose main role is to maintain serum phosphate levels in the normal range, acting via its co-receptor Klotho; however, its activity may also be related to anemia and inflammation. In this review, the regulation of Epo and FGF-23 and the molecular mechanisms of their action are outlined. Furthermore, the complex interaction between EPO and FGF-23 is discussed, as well as their association with other anemia-related factors and processes such as Klotho, vitamin D, and iron deficiency. Together, these may be part of a "kidney-bone marrow-bone axis" that promotes CKD-MBD.
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