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Plasma levels of fibroblast growth factor-23 and mineral metabolism in diabetic and non-diabetic patients on chronic hemodialysis

  • Nephrology - Original Paper
  • Published:
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Abstract

Objective

Fibroblast growth factor (FGF) 23 is a circulating factor that regulates phosphate (P) metabolism. Since higher P levels are associated with vascular calcification, we examined the role of serum FGF-23 levels in P metabolism and vascular calcification in hemodialysis (HD) patients with and without diabetes mellitus (DM).

Materials and methods

Chronic HD patients with DM (n = 39) and without DM (n = 50) were enrolled. Serum samples were obtained before the start of dialysis sessions, and the FGF-23 levels were determined by enzyme-linked immunosorbent assay. Abdominal computed tomography (CT) scan was performed, and the aortic calcification index (ACI) was determined by one examiner, blinded to the patient characteristics. Measurements of bone mineral density (BMD) were performed at the time of ACI estimation.

Results

Log plasma FGF-23 levels were higher in non-DM (3.74 ± 0.71 pg/ml) than in DM (3.35 ± 0.74 pg/ml) patients. The log FGF-23 correlated positively with serum creatinine (r = 0.424, P < 0.0001), albumin (r = 0.225, P = 0.0337), Ca (r = 0.392, P = 0.0001), P (r = 0.735, P < 0.0001), and Ca × P product (r = 0.780, P < 0.0001). There were negative correlations between log FGF-23 and age (r = −0.208, P = 0.0497), glucose (r = −0.231, P = 0.0294), and CRP (r = −0.222, P = 0.0359). Multiple regression analyses were performed to explore the correlations between plasma FGF-23 and other factors associated with vascular calcification in all HD patients. Independent variables were selected based on the results of univariate analyses. The significant factors associated with FGF-23 in HD patients were age, serum levels of creatinine, albumin, glucose, Ca, P, and Ca × P product. Plasma FGF levels did not correlate significantly with either ACI or BMD in these patients.

Conclusion

Our findings indicate that the plasma FGF-23 level is associated with calcium-phosphate metabolism disorders, but not with aortic calcification, in both non-DM and DM patients on chronic HD. In addition, plasma FGF-23 is associated with serum levels of creatinine and albumin. Therefore, the plasma FGF-23 level may provide a reliable marker for Ca and P imbalance and nutritional status in HD patients.

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Acknowledgements

We thank all medical personnel of the dialysis Units in Koshin Clinic for collecting the medical records. This work was supported by grants from the Japan Research Promotion Society for Cardiovascular Diseases the International Research and the Educational Institute and for Integrated Medical Sciences (IREIMS).

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Authors and Affiliations

  1. Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Fumiko Kojima, Keiko Uchida, Tetsuya Ogawa & Kosaku Nitta

  2. Dialysis Unit, Shinjuku Koshin Clinic, Shinjuku-ku, Tokyo, Japan

    Yoshiko Tanaka

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  1. Fumiko Kojima
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  2. Keiko Uchida
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  3. Tetsuya Ogawa
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  5. Kosaku Nitta
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Correspondence to Kosaku Nitta.

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Kojima, F., Uchida, K., Ogawa, T. et al. Plasma levels of fibroblast growth factor-23 and mineral metabolism in diabetic and non-diabetic patients on chronic hemodialysis. Int Urol Nephrol 40, 1067–1074 (2008). https://doi.org/10.1007/s11255-008-9462-4

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  • DOI: https://doi.org/10.1007/s11255-008-9462-4

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