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Disordered FGF23 and mineral metabolism in children with CKD.

Publication ,  Journal Article
Portale, AA; Wolf, M; Jüppner, H; Messinger, S; Kumar, J; Wesseling-Perry, K; Schwartz, GJ; Furth, SL; Warady, BA; Salusky, IB
Published in: Clin J Am Soc Nephrol
February 2014

BACKGROUND AND OBJECTIVES: In children with CKD, information is limited regarding the prevalence and determinants of fibroblast growth factor 23 excess and 1,25-dihyroxyvitamin D deficiency across the spectrum of predialysis CKD. This study characterized circulating concentrations of fibroblast growth factor 23 and 1,25-dihyroxyvitamin D, and investigated their interrelationships and associations with GFR and secondary hyperparathyroidism in children with CKD who were enrolled in the Chronic Kidney Disease in Children observational cohort study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Plasma fibroblast growth factor 23 concentrations and determinants of mineral metabolism were measured in 464 children ages 1-16 years with predialysis CKD. GFR was measured by plasma disappearance of iohexol in 70% of participants and estimated by the Chronic Kidney Disease in Children estimating equation using serum creatinine and cystatin C concentrations in the remainder of the participants. Participants were grouped according to CKD stage and by 10-ml/min categories of GFR. RESULTS: Median GFR for the cohort was 45 ml/min per 1.73 m(2) (interquartile range=33-57; range=15-109). Plasma fibroblast growth factor 23 concentration was above the normal range in 67% of participants (with higher levels observed among participants with lower GFR) before higher levels of serum parathyroid hormone and phosphorus were observed. Plasma fibroblast growth factor 23 levels were 34% higher in participants with glomerular disease than in participants with nonglomerular disease, despite similar GFR. Serum phosphorus levels, adjusted for age, were significantly lower at GFR of 60-69 ml/min per 1.73 m(2) than higher GFR, but thereafter they became higher in parallel with fibroblast growth factor 23 as GFR declined. Serum 1,25-dihyroxyvitamin D concentrations were lower in those participants with low GFR values, high fibroblast growth factor 23 levels, 25-hydroxyvitamin D deficiency, and proteinuria. Secondary hyperparathyroidism was present in 55% of participants with GFR<50 ml/min per 1.73 m(2). CONCLUSION: In children with predialysis CKD, high plasma fibroblast growth factor 23 is the earliest detectable abnormality in mineral metabolism, and levels are highest in glomerular diseases.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

February 2014

Volume

9

Issue

2

Start / End Page

344 / 353

Location

United States

Related Subject Headings

  • Vitamin D Deficiency
  • Vitamin D
  • Urology & Nephrology
  • United States
  • Severity of Illness Index
  • Renal Insufficiency, Chronic
  • Predictive Value of Tests
  • Phosphorus
  • Parathyroid Hormone
  • Kidney
 

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Portale, A. A., Wolf, M., Jüppner, H., Messinger, S., Kumar, J., Wesseling-Perry, K., … Salusky, I. B. (2014). Disordered FGF23 and mineral metabolism in children with CKD. Clin J Am Soc Nephrol, 9(2), 344–353. https://doi.org/10.2215/CJN.05840513
Portale, Anthony A., Myles Wolf, Harald Jüppner, Shari Messinger, Juhi Kumar, Katherine Wesseling-Perry, George J. Schwartz, Susan L. Furth, Bradley A. Warady, and Isidro B. Salusky. “Disordered FGF23 and mineral metabolism in children with CKD.Clin J Am Soc Nephrol 9, no. 2 (February 2014): 344–53. https://doi.org/10.2215/CJN.05840513.
Portale AA, Wolf M, Jüppner H, Messinger S, Kumar J, Wesseling-Perry K, et al. Disordered FGF23 and mineral metabolism in children with CKD. Clin J Am Soc Nephrol. 2014 Feb;9(2):344–53.
Portale, Anthony A., et al. “Disordered FGF23 and mineral metabolism in children with CKD.Clin J Am Soc Nephrol, vol. 9, no. 2, Feb. 2014, pp. 344–53. Pubmed, doi:10.2215/CJN.05840513.
Portale AA, Wolf M, Jüppner H, Messinger S, Kumar J, Wesseling-Perry K, Schwartz GJ, Furth SL, Warady BA, Salusky IB. Disordered FGF23 and mineral metabolism in children with CKD. Clin J Am Soc Nephrol. 2014 Feb;9(2):344–353.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

February 2014

Volume

9

Issue

2

Start / End Page

344 / 353

Location

United States

Related Subject Headings

  • Vitamin D Deficiency
  • Vitamin D
  • Urology & Nephrology
  • United States
  • Severity of Illness Index
  • Renal Insufficiency, Chronic
  • Predictive Value of Tests
  • Phosphorus
  • Parathyroid Hormone
  • Kidney