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The relationship between FGF23 and anemia in HD and renal transplant patients

  • Nephrology - Original Paper
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Abstract

Purpose

Recent studies claim that FGF23 is also associated with anemia and inflammation. In this study, the relationship between FGF23 and anemia in hemodialysis (HD) and renal transplantation patients (RTx patients) patients was investigated.

Methods

This was a cross-sectional study involving 40 RTx patients (13 females, 27 males; mean age, 45.93 ± 12.49 years) who had transplantation at least 6 months before, 25 HD patients (12 females, 13 males; mean age, 54.72 ± 15.5 years), and 20 healthy control subjects (13 females, 7 males; mean age, 36.7 ± 9.38 years). FGF23 was studied using Elisa method. Parameters such as iron, ferritin, total iron binding capacity, and transferrin saturation were assessed.

Results

FGF23 level was significantly higher in HD patients when compared with the RTx patients and control groups. In the bivariate correlation analysis, hemoglobin was positively correlated with albumin (r = 0.681, p = 0.000), ferritin (r = 0.446, p = 0.043), and negatively correlated with CRP (r = − 0.476, p = 0.016) and FGF23 (r = 0.493, p = 0.043). FGF23 was found to be an independent predictor of decreased hemoglobin in HD patients. In addition, this association was observed to disappear after transplantation.

Conclusion

While FGF23 is closely related to hemoglobin levels in HD patients, we have shown that this relationship disappears after transplantation.

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References

  1. Jüppner H (2011) Phosphate and FGF-23. Kidney Int 79121:S24–S27. https://doi.org/10.1038/ki.2011.27

    Article  CAS  PubMed  Google Scholar 

  2. Vlagopoulos PT, Tighiouart H, Weiner DE, Griffith J, Pettitt D, Salem DN, Levey AS, Sarnak MJ (2005) Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol 16:3403–3410

    Article  Google Scholar 

  3. Gutiérrez OM, Mannstadt M (2008) Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359:584–592

    Article  Google Scholar 

  4. Willerson JT (2004) Inflammation as a cardiovascular risk factor. Circulation 109:II2–II10

    Article  Google Scholar 

  5. David V, Francis C, Babitt JL (2017) Ironing out the crosstalk between FGF23 and inflammation. Am J Physiol Ren Physiol 312:F1–F8. https://doi.org/10.1152/ajprenal.00359.2016

    Article  CAS  Google Scholar 

  6. Francis C, David V (2016) Inflammation regulates fibroblast growth factor 23 production. Curr Opin Nephrol Hypertens 25:325–332

    Article  CAS  Google Scholar 

  7. Brian C, Christian F (2019) The role of fibroblast growth factor 23 in inflammation and anemia. Int J Mol Sci 20(17):4195

    Article  Google Scholar 

  8. Astor BC, Muntner P, Levin A, Eustace JA, Coresh J (2002) Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med 162:1401–1408

    Article  Google Scholar 

  9. Levin A (2002) Anemia and left ventricular hypertrophy in chronic kidney disease populations: a review of the current state of knowledge. Kidney Int 61(Supplement 80):S35–S38

    Article  Google Scholar 

  10. Vanrenterghem Y, Ponticelli C, Morales JM, Abramowicz D, Baboolal K, Eklund B, Kliem V, Legendre C, Morais Sarmento AL, Vincenti F (2003) Prevalence and management of anemia in renal transplant recipients: a European survey. Am J Transplant 3(7):835–845

    Article  Google Scholar 

  11. Chhabra D, Grafals M, Skaro AI, Parker M, Gallon L (2008) Impact of anemia after renal transplantation on patient and graft survival and on rate of acute rejection. Clin J Am Soc Nephrol 3(4):1168–1174

    Article  CAS  Google Scholar 

  12. Kovesdy CP, Trivedi BK, Kalantar-Zadeh K, Anderson JE (2006) Association of anemia with outcomes in men with moderate and severe chronic kidney disease. Kidney Int 69:560–564

    Article  CAS  Google Scholar 

  13. Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM (2003) Association of high serum creatinine and anemia increases the risk of coronary events: results from the prospective community-based atherosclerosis risk in communities (ARIC) study. J Am Soc Nephrol 14:2919–2925

    Article  CAS  Google Scholar 

  14. Kovesdy CP, Quarles LD (2013) Fibroblast growth factor-23: what we know, what we don’t know, and what we need to know. Nephrol Dial Transplant 28:2228–2236

    Article  CAS  Google Scholar 

  15. Fliser D et al (2007) Fibroblast growth factor 23 (FGF23) predicts progression of chronic kidney disease: the Mild to Moderate Kidney Disease (MMKD) Study. J Am Soc Nephrol 18:2600–2608

    Article  CAS  Google Scholar 

  16. Khan AM, Chirinos JA, Litt H, Yang W, Rosas SE (2012) FGF-23 and the progression of coronary arterial calcification in patients new to dialysis. Clin J Am Soc Nephrol 7:2017–2022

    Article  CAS  Google Scholar 

  17. Gutierrez OM et al (2009) Fibroblast growth factor 23 and left ventricular hypertrophy in chronic kidney disease. Circulation 119:2545–2552

    Article  CAS  Google Scholar 

  18. Scialla JJ et al (2014) Fibroblast growth factor-23 and cardiovascular events in CKD. J Am Soc Nephrol 25:349–360

    Article  CAS  Google Scholar 

  19. Gutierrez OM et al (2008) Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359:584–592

    Article  CAS  Google Scholar 

  20. Steinman TI (2000) Serum albumin: its significance in patients with ESRD. Semin Dial 13(6):404–408

    Article  CAS  Google Scholar 

  21. Yeun JY, Kaysen GA (1998) Factors influencing serum albumin in dialysis patients. Am J Kidney Dis 32:S118–S125

    Article  CAS  Google Scholar 

  22. Bindra K, Berry C, Rogers J, Stewart N, Watts M, Christie J, Cobbe SM, Eteiba H (2006) Abnormal haemoglobin levels in acute coronary syndromes. J Assoc of Physician QJM99:851–862

    Google Scholar 

  23. Agarwal R, Davis JL, Smith L (2008) Serum albumin ıs strongly associated with erythropoietin sensitivity in hemodialysis patients. CJASN 3(1):98–104

    Article  CAS  Google Scholar 

  24. NKF-K, DOQI (2001) Clinical Practice Guidelines for anemia of chronic kidney disease: update 2000. Am J Kidney Dis 37:S182–S238

    Article  Google Scholar 

  25. Coyne DW (2006) Iron indices: what do they really mean? Kidney Int 101:S4–S8

    Article  CAS  Google Scholar 

  26. Malyszko J, Mysliwiec M (2007) Hepcidin in anemia and inflammation in chronic kidney disease. Kidney Blood Press Res 30:15–30

    Article  CAS  Google Scholar 

  27. Akalin N et al (2014) Prognostic importance of fibroblast growth factor-23 in dialysis patients. Int J Nephrol 2014:602034

    Article  Google Scholar 

  28. Honda H et al (2017) High fibroblast growth factor 23 levels are associated with decreased ferritin levels and increased intravenous iron doses in hemodialysis patients. PLoS ONE 12(5):e0176984

    Article  Google Scholar 

  29. Eser B, Yayar O, Buyukbakkal M et al (2015) Fibroblast growth factor is associated to left ventricular mass index, anemia and low values of transferrin saturation. Nefrologia 35(5):465–472

    Article  Google Scholar 

  30. Tsai M-H, Leu J-G et al (2016) High fibroblast growth factor 23 levels associated with low hemoglobin levels in patients with chronic kidney disease stages 3 and 4. Medicine 95(11):e3049

    Article  CAS  Google Scholar 

  31. Coe LM, Madathil SV, Casu C et al (2014) FGF-23 is a negative regulator of prenatal and postnatal erythropoiesis. J Biol Chem 289(14):9795–9810

    Article  CAS  Google Scholar 

  32. Adams GB, Chabner KT, Alley IR, Olson DP, Szczepiorkowski ZM, Poznansky MC, Kos CH, Pollak MR, Brown EM, Scadden DT (2005) Stem cell engraftment at the endosteal niche is specified by the calcium-sensing receptor. Nature 439:599–603. https://doi.org/10.1038/nature04247

    Article  CAS  PubMed  Google Scholar 

  33. Sun CC, Vaja V, Babitt JL, Lin HY (2012) Targeting the hepcidin-ferroportin axis to develop new treatment strategies for anemia of chronic disease and anemia of inflammation. Am J Hematol 87(4):392–400

    Article  CAS  Google Scholar 

  34. Singh S, Grabner A, Yanucil C, Schramm K, Czaya B, Krick S, Czaja MJ, Bartz R, Abraham R, Di Marco GS, Brand M, Wolf M, Faul C (2016) Fibroblast growth factor 23 directly targets hepatocytes to promote inflammation in chronic kidney disease. Kidney Int 90:985–996

    Article  CAS  Google Scholar 

  35. David V, Martin A, Isakova T, Spaulding C, Qi L, Ramirez V, Zumbrennen-Bullough KB, Sun CC, Lin HY, Babitt JL, Wolf M (2016) Inflammation and functional iron deficiency regulate fibroblast growth factor 23 production. Kidney Int 89:135–146

    Article  CAS  Google Scholar 

  36. Agoro R, Montagna A, Goetz R, Aligbe O, Singh G, Coe LM, Mohammadi M, Rivella S, Sitara D (2018) Inhibition of fibroblast growth factor 23 (FGF23) signaling rescues renal anemia. FASEB J 32:3752–3764

    Article  CAS  Google Scholar 

  37. Shah N, Al-Khoury S, Afzali B, Covic A, Roche A, Marsh J, Macdougall IC, Goldsmith DJ (2006) Posttransplantation anemia in adult renal allograft recipients: prevalence and predictors. Transplantation 81:1112–1118

    Article  Google Scholar 

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Correspondence to Ismail Baloglu.

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Baloglu, I., Ozer, H., Ozturk, Y. et al. The relationship between FGF23 and anemia in HD and renal transplant patients. Int Urol Nephrol 54, 1117–1122 (2022). https://doi.org/10.1007/s11255-021-02982-9

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  • DOI: https://doi.org/10.1007/s11255-021-02982-9

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