Pediatric Nephrology

, Volume 29, Issue 1, pp 103–109

High serum phosphorus and FGF 23 levels are associated with progression of coronary calcifications

  • Poyyapakkam R. Srivaths
  • Stuart L. Goldstein
  • Rajesh Krishnamurthy
  • Douglas M. Silverstein
Original Article

DOI: 10.1007/s00467-013-2575-8

Cite this article as:
Srivaths, P.R., Goldstein, S.L., Krishnamurthy, R. et al. Pediatr Nephrol (2014) 29: 103. doi:10.1007/s00467-013-2575-8

Abstract

Background

Coronary calcifications (CC) portend increased mortality in adults receiving hemodialysis (HD), however the risk factors associated with CC progression are not well known in pediatric patients. Our previous cross-sectional studies demonstrated high CC prevalence (31 %) in pediatric patients, which were significantly associated with high serum phosphorus (P), fibroblast growth factor 23 (FGF) levels, dialysis vintage, and low cholesterol. The current study was undertaken to determine and elucidate CC progression in pediatric HD patients.

Methods

A 1-year prospective longitudinal study of 16 pediatric patients (ten male; mean age, 16.9 ± 3 years; range, 10.1–20.4 years) receiving chronic HD was conducted.

Results

CC were observed in five of 16 (31.3 %) patients on baseline computed tomogram (CT) scan; 14/16 patients underwent 1-year CT. All patients with initial CC who completed CT at 1 year (3/5) progressed; one patient had new CC and none of the patients had resolved CC. Mean Agatston score increased from 23.4 ± 18.06 HU (baseline) to 169 ± 298.9 HU. Patients with CC progression had higher mean serum P (8.6 ± 1.8 mg/dl vs. 6.3 ± 1.1 mg/dl, p = 0.015) and FGF 23 levels (3,994 ± 860.5 pg/ml vs. 2,327 ± 1,206.4 pg/ml, p = 0.028). Serum P and FGF 23 levels were positively correlated with final Agatston scores (R = 0.65, p = 0.01 for serum P and R = 0.54, p = 0.045 for FGF 23) and change in Agatston scores (R = 0.65, p = 0.01 for serum P and R = 0.52, p = 0.048 for FGF 23).

Conclusions

Our study shows that CC is progressive in pediatric patients receiving HD and that increased serum P and FGF 23 levels are associated with this progression.

Keywords

Hemodialysis Pediatric Children 

Copyright information

© IPNA 2013

Authors and Affiliations

  • Poyyapakkam R. Srivaths
    • 1
  • Stuart L. Goldstein
    • 2
  • Rajesh Krishnamurthy
    • 3
  • Douglas M. Silverstein
    • 4
  1. 1.Texas Children’s Hospital—Pediatric NephrologyBaylor College of MedicineHoustonUSA
  2. 2.Section of Pediatric NephrologyCincinnati Children’s HospitalCincinnatiUSA
  3. 3.Texas Children’s Hospital—RadiologyBaylor College of MedicineHoustonUSA
  4. 4.Renal Devices BranchFood and Drug AdministrationSilver SpringUSA

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