Elevated FGF23 Levels Are Associated with Impaired Calcium-Mediated Suppression of PTH in ESRD
| Autor: | James B. Wetmore, Hema Gutta, L. Darryl Quarles, Ron Krebill, Peter W. Santos, Rochelle Menard, Jonathan D. Mahnken |
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| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Fibroblast growth factor 23 endocrine system medicine.medical_specialty endocrine system diseases Endocrinology Diabetes and Metabolism Clinical Biochemistry Parathyroid hormone Context (language use) urologic and male genital diseases Biochemistry Endocrinology Translational Highlights from Jcem Renal Dialysis Internal medicine Vitamin D and neurology Humans Medicine Molecular Biology Aged Calcium metabolism Kidney business.industry Biochemistry (medical) General Medicine Middle Aged medicine.disease Fibroblast Growth Factors Fibroblast Growth Factor-23 stomatognathic diseases medicine.anatomical_structure Parathyroid Hormone Kidney Failure Chronic Original Article Calcium Female Hyperparathyroidism Secondary Parathyroid gland Secondary hyperparathyroidism business hormones hormone substitutes and hormone antagonists |
| Popis: | Context: The positive association of elevated fibroblast growth factor-23 (FGF23) with PTH levels in the setting of secondary hyperparathyroidism is paradoxical to the purported effects of FGF23 to suppress PTH secretion. Objective: We used dynamic calcium-mediated suppression of PTH levels in hemodialysis (HD) patients to determine the relationship between FGF23 levels and parathyroid gland function. Design: HD patients with elevated PTH were washed out of vitamin D analogs and/or calcimimetics and then exposed them to a high-calcium dialysate bath designed to suppress PTH. Setting: The study was conducted at an outpatient HD unit of an academic medical center. Participants: Eighteen maintenance HD patients with elevated PTH levels participated in the study. Main Outcome Measures: Ionized calcium (iCa), PTH, and FGF23 levels were measured during HD. The slope of the relationship between iCa and PTH (a marker of parathyroid gland mass) and the iCa level required for a 50% reduction in PTH were determined, and the association of these with FGF23 levels was determined. Results: Increased baseline log FGF23 levels were associated with putative alterations in gland mass as estimated by significantly shallower slopes of the iCa/PTH suppression curves (P = 0.0004), but there was no association between FGF23 and calcium sensing as measured by ionized Ca associated with a 50% suppression of PTH (P = 0.38). FGF23 levels decreased significantly during HD, but this change was not correlated with decrements in either renal phosphate or PTH. Conclusions: High FGF23 levels may be a marker for parathyroid gland hyperplasia in HD patients. Acute reductions in neither PTH nor renal phosphate during dialysis correlated with PTH suppression. |
| Databáze: | OpenAIRE |
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