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The effects of iron on FGF23-mediated Ca–P metabolism in CKD patients

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Abstract

Background

Fibroblast growth factor 23 (FGF23) is an important counterregulatory hormone for phosphate homeostasis. Since it has been reported that iron administration induces hypophosphatemic osteomalacia by triggering FGF23 synthesis, we hypothesized that iron administration might lead to a further increase in FGF23, resulting in alterations to Ca–P metabolism in a stage 5 CKD population.

Methods

This cross-sectional study was performed in a single center, and involved 73 hemodialysis patients (47.7 ± 15.74 years old, 68.5 % men), 29 peritoneal dialysis patients (44.55 ± 15.05 years old, 62.1 % men), and 55 healthy (43.57 ± 14.36 years old, 55.6 % men) subjects. The dialysis group was subcategorized according to iron therapy administration into users and nonusers.

Results

The median iFGF23 level was significantly higher in the dialysis population than in the healthy controls [88.050 (25.2–1038.3) pg/ml versus 46.95 (2.4–356) pg/ml (p < 0.001)]. In the dialysis population, a significantly lower median iFGF23 level was observed in iron therapy users than in nonusers [87.6 (25.2–1038.3) versus 119 (51.6–1031); respectively, p = 0.045]. A significant negative association between iron administration and iFGF23 level was revealed by both univariate (r = −0.237, p = 0.016) and multivariate (β = −0.221, p = 0.032) analysis. No association was found between iFGF23 and serum ferritin and iron levels. Also, there was no association between iron therapy and serum phosphate level.

Conclusion

In contrast to what is seen for the general population, this study showed that there was a negative relationship between iron administration and serum iFGF23 level in a dialysis population. We can therefore conclude that if high levels of FGF23 are harmful, iron therapy may have a beneficial effect on bone metabolism by reducing FGF23 levels in a dialysis population.

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Acknowledgments

This study was conducted through funding from the Gazi University Faculty of Medicine and the Postgraduate Medicine Education Association. All authors contributed to the design of the study, data collection, data interpretation, and the writing of the manuscript. Data from this manuscript were presented in part at the 2011 World Congress of Nephrology in Vancouver, Canada.

Conflict of interest

None have financial or other contractual agreements that might cause conflict of interest.

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Author notes

  1. Serpil Muge Deger

    Present address: Division of Nephrology, Vanderbilt University Medical Center, S-3223 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232, USA

Authors and Affiliations

  1. Department of Internal Medicine, Department of Nephrology, Gazi University Faculty of Medicine, Besevler, Ankara, 06500, Turkey

    Serpil Muge Deger, Yasemin Erten, Ulver Boztepe Derici, Kadriye Altok Reis & Kursad Onec

  2. Department of Biochemistry, Gazi University Faculty of Medicine, Besevler, Ankara, 06500, Turkey

    Ozge Tugce Pasaoglu & Hatice Pasaoglu

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  1. Serpil Muge Deger
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Correspondence to Serpil Muge Deger.

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Deger, S.M., Erten, Y., Pasaoglu, O.T. et al. The effects of iron on FGF23-mediated Ca–P metabolism in CKD patients. Clin Exp Nephrol 17, 416–423 (2013). https://doi.org/10.1007/s10157-012-0725-0

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  • DOI: https://doi.org/10.1007/s10157-012-0725-0

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