Factors associated with 1-year changes in serum fibroblast growth factor 23 levels in pediatric patients with chronic kidney disease

Yamamura-Miyazaki, Natsumi; Michigami, Toshimi; Ozono, Keiichi; Yamamoto, Katsusuke; Hasuike, Yukiko

doi:10.1007/s10157-022-02238-5

Cited by 5 publications

(2 citation statements)

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“…Other cohort studies of pediatric patients with CKD have evaluated associations between hemoglobin concentrations and FGF23 levels [ 46 – 48 ]. One cross-sectional study observed that hemoglobin was inversely associated with total FGF23, but was not associated with intact FGF23 [ 46 ], similar to our findings.…”

Section: Discussionmentioning

confidence: 99%

“…One cross-sectional study observed that hemoglobin was inversely associated with total FGF23, but was not associated with intact FGF23 [ 46 ], similar to our findings. Another study also found that hemoglobin was inversely associated with total FGF23 [ 47 ], while a third study observed that hemoglobin was inversely associated with intact FGF23 [ 48 ]. However, all three of these cohorts were relatively small (53–62 patients), limiting the number of covariables for which the results could be adjusted; the former two studies included patients with kidney transplants or on dialysis, respectively; and the latter two studies used different FGF23 assays than those used in the present study.…”

Section: Discussionmentioning

confidence: 99%

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Associations between anemia and FGF23 in the CKiD study

Thomas,

Klomhaus,

Laster

et al. 2023

Pediatr Nephrol

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Background Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that plays a central role in chronic kidney disease-mineral bone disorder and is associated with CKD progression and cardiovascular morbidity. Factors related to CKD-associated anemia, including iron deficiency, can increase FGF23 production. This study aimed to assess whether anemia and/or iron deficiency are associated with increased circulating concentrations of FGF23 in the large, well-characterized Chronic Kidney Disease in Children (CKiD) study cohort. Methods Hemoglobin concentrations, iron parameters, C-terminal (total) FGF23, intact FGF23, and relevant covariables were measured in cross-sectional analysis of CKiD study subjects. Results In 493 pediatric patients with CKD (median [interquartile range] age 13 [9, 16] years), the median estimated glomerular filtration rate was 48 [35, 61] ml/min/1.73 m2, and 103 patients (21%) were anemic. Anemic subjects had higher total FGF23 concentrations than non-anemic subjects (204 [124, 390] vs. 109 [77, 168] RU/ml, p < 0.001). In multivariable linear regression modeling, anemia was independently associated with higher total FGF23, after adjustment for demographic, kidney-related, mineral metabolism, and inflammatory covariables (standardized β (95% confidence interval) 0.10 (0.04, 0.17), p = 0.002). In the subset of subjects with available iron parameters (n = 191), iron deficiency was not associated with significantly higher total FGF23 concentrations. In the subgroup that had measurements of both total and intact FGF23 (n = 185), in fully adjusted models, anemia was significantly associated with higher total FGF23 (standardized β (95% CI) 0.16 (0.04, 0.27), p = 0.008) but not intact FGF23 (standardized β (95% CI) 0.02 (−0.12, 0.15), p = 0.81). Conclusions In this cohort of pediatric patients with CKD, anemia was associated with increased total FGF23 levels but was not independently associated with elevated intact FGF23, suggesting possible effects on both FGF23 production and cleavage. Further studies are warranted to investigate non-mineral factors affecting FGF23 production and metabolism in CKD. Graphical abstract

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Section: Discussionmentioning

confidence: 99%