Abstract | BACKGROUND:
Fibroblast growth factor 23 (FGF23) is a phosphaturic hormone that is secreted from bone and serum level increases as renal function declines. Higher levels of FGF23 are associated with increased mortality in hemodialysis-patients and in patients with chronic kidney disease (CKD) stage 2-4. The use of active vitamin D and phosphate binders as recommended in international guidelines, may affect the level of FGF23 and thereby clinical outcome. We investigated the effects of a phosphate binder and active vitamin D on the serum levels of intact FGF23 (iFGF23) and intact parathyroid hormone (iPTH) in patients with CKD stage 3b (glomerular filtration rate (GFR) 30-44 ml/min/1.73 m(2)). METHODS: RESULTS: There were no treatment effects on the iFGF23 and iPTH levels overall. In group-1 the iFGF23 level was higher after treatment with alphacalcidol compared with sevelamer carbonate (mean 105.8 ± 41.6 vs. 79.1 ± 36.5 pg/ml, p = 0.047 (CI: 0.4-52.9), and the iPTH level was lower (median: 26.5, range: 14.6-55.2 vs. median 36.1, range 13.4-106.9 pg/ml, p = 0.011). In group-2 the iFGF23 level increased non-significantly after treatment with sevelamer carbonate and throughout the washout period. CONCLUSIONS: In this crossover trial with alphacalcidol and sevelamer carbonate in patients with CKD stage 3b, the levels of iFGF23 were not significantly different after the two treatments. However, in the group of patients initiating therapy with sevelamer carbonate the iFGF23 levels seemed to increase while this response was mitigated in the group of patients given alphacalcidol followed by sevelamer carbonate. This may have therapeutic implications on choice of first line therapy. The number of patients is small and this conclusion is in part based on subgroup analysis. It is therefore important that these results are confirmed in larger studies. TRIAL REGISTRATION: TRIAL REGISTRATION NUMBER: European Clinical Trial Database (EudraCT) 2010-020415-36 and Clinical Trials.gov NCT01231438.
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Authors | Inger H Bleskestad, Harald Bergrem, Anders Hartmann, Kristin Godang, Lasse G Gøransson |
Journal | BMC nephrology
(BMC Nephrol)
Vol. 13
Pg. 49
(Jun 28 2012)
ISSN: 1471-2369 [Electronic] England |
PMID | 22742720
(Publication Type: Journal Article, Randomized Controlled Trial)
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Chemical References |
- Biomarkers
- Chelating Agents
- FGF23 protein, human
- Parathyroid Hormone
- Polyamines
- Vitamins
- Vitamin D
- Fibroblast Growth Factors
- Fibroblast Growth Factor-23
- Sevelamer
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Topics |
- Aged
- Biomarkers
(blood)
- Chelating Agents
(administration & dosage)
- Cross-Over Studies
- Drug Therapy, Combination
- Female
- Fibroblast Growth Factor-23
- Fibroblast Growth Factors
(blood)
- Humans
- Hyperparathyroidism, Secondary
(blood, etiology, prevention & control)
- Male
- Parathyroid Hormone
(blood)
- Polyamines
(administration & dosage)
- Renal Insufficiency, Chronic
(blood, complications, drug therapy)
- Sevelamer
- Treatment Outcome
- Vitamin D
(administration & dosage)
- Vitamins
(administration & dosage)
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