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Elevated FGF 23 and phosphorus are associated with coronary calcification in hemodialysis patients

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Abstract

Increased mortality of adult chronic hemodialysis (HD) patients is associated with coronary calcifications (CC), increased serum phosphorus (P), use of calcium (Ca)-containing P-binders, and vitamin D deficiency. Serum concentration of fibroblast growth factor 23 (FGF 23) is markedly elevated in adults receiving dialysis and is independently associated with increased mortality. Although coronary calcifications have been described in pediatric and adult HD patients, no significant association between serum FGF 23 and CC has been reported. In our study, 5/16 patients had CC. Patients with CC were older, had longer dialysis vintage and higher serum P. Serum Ca, total PTH, elemental Ca intake, and calcitriol doses were not different for CC patients. Serum FGF 23 levels were markedly elevated in all patients (mean 4,024, range 874–8,253), but significantly higher in patients with CC (4,247 ± 10,35 vs 2,427 ± 11,92, p = 0.01) and positively correlated with Agatston calcification score (r = 0.69, p = 0.003) and serum P (r = 0.49, p = 0.05). Using multivariate analysis, serum FGF 23 and serum P remained the most significant factors associated with Agatston score. This study confirms the occurrence of CC in pediatric HD patients and is the first to show a significant association between CC and elevated serum FGF 23 in children.

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Authors and Affiliations

  1. Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, 77030, USA

    Poyyapakkam R. Srivaths & Eileen D. Brewer

  2. Division of Nephrology and Hypertension & Heart institute, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA

    Stuart L. Goldstein

  3. Department of Pediatrics, Pediatric Nephrology, Children’s National Medical Center, Washington, DC, WA, USA

    Douglas M. Silverstein

  4. Department of Pediatrics, Radiology, Texas Children’s Hospital, Houston, TX, 77030, USA

    Rajesh Krishnamurthy

  5. 1102 Bates Street, Ste 260, Houston, 77030, TX, USA

    Poyyapakkam R. Srivaths

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  1. Poyyapakkam R. Srivaths
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  2. Stuart L. Goldstein
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  3. Douglas M. Silverstein
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  5. Eileen D. Brewer
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Correspondence to Poyyapakkam R. Srivaths.

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Srivaths, P.R., Goldstein, S.L., Silverstein, D.M. et al. Elevated FGF 23 and phosphorus are associated with coronary calcification in hemodialysis patients. Pediatr Nephrol 26, 945–951 (2011). https://doi.org/10.1007/s00467-011-1822-0

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  • DOI: https://doi.org/10.1007/s00467-011-1822-0

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