Phosphate control in reducing FGF23 levels in hemodialysis patients

Rodelo-Haad, Cristian; Rodríguez‐Ortiz, María E.; Martín‐Malo, Alejandro; Mier, M. Victoria Pendón-Ruiz de; Agüera, María Luisa; Muñoz‐Castañeda, Juan R.; Soriano, Sagrario; Caravaca, Francisco; Alvarez‐Lara, María Antonia; Felsenfeld, Arnold J.; Aljama, Pedro; Rodriguez, Mariano

doi:10.1371/journal.pone.0201537

Cited by 32 publications

(33 citation statements)

References 57 publications

(52 reference statements)

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“…For instance, intravenous iron administration, which was not accounted for in this analysis, increases intact FGF23 among dialysis patients independent of serum calcium and phosphorus levels [20,21]. Long-term control of serum phosphorus with non-calcium based phosphate binders may result in decreases in FGF23 levels [22,23], while active vitamin D stimulates FGF23 production [24]. Our study did not account for changes in serum phosphorus, type of phosphate binder, or prescription of active vitamin D; however, low baseline serum phosphorus and no baseline use of active vitamin D analogues were strongly associated with the low stable FGF23 trajectory.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Fibroblast Growth Factor 23 Trajectories in Chronic Hemodialysis Patients: Lessons from the HEMO Study

Jovanovich¹,

You²,

Isakova³

et al. 2019

Am J Nephrol

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Background: Long-term patterns of fibroblast growth factor 23 (FGF23) are poorly characterized among dialysis patients. Objectives: To identify different FGF23 trajectories and determine clinical factors that predict distinct FGF23 trajectories and whether FGF23 trajectories differ in regard to their associations with all-cause mortality among prevalent hemodialysis patients. Methods: The HEMO study was a randomized multicenter study evaluating the effects of high-dose vs. standard-dose and high-flux vs. low-flux hemodialysis on mortality. We measured intact FGF23 levels in stored serum samples at baseline and annually among 919 HEMO participants and identified FGF23 trajectories using group-based modeling. Logistic regression determined predictors of trajectories. Cox regression models evaluated the association between trajectory and all-cause mortality. Results: We identified 5 distinct FGF23 trajectory groups during the initial 24 months: low stable, low increasing, elevated increasing, elevated decreasing, and elevated stable. In multivariable models, diabetes, high dose dialysis, no venous catheter, low serum calcium, phosphorus, and interleukin-6, no vitamin D analog use, and greater residual kidney function were associated with the low stable trajectory group compared to the elevated stable group. High flux dialysis, no venous catheter, and low serum phosphorus and 25-hydroxyvitamin D were associated with the elevated decreasing trajectory group compared to the elevated stable group. After full adjustment, the low stable trajectory group was associated with reduced mortality (hazard ratio [HR] 0.61; 95% CI 0.41–0.91) compared to the elevated stable trajectory group. Conclusions: We identified 5 distinct FGF23 trajectories over 24 months among HEMO study participants including a decreasing trajectory. The low stable FGF23 trajectory was associated with a reduced HR of all-cause mortality.

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Section: Discussion/conclusionmentioning

confidence: 99%

Fibroblast Growth Factor 23 Trajectories in Chronic Hemodialysis Patients: Lessons from the HEMO Study

Jovanovich¹,

You²,

Isakova³

et al. 2019

Am J Nephrol

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“…Serum FGF23 concentrations have been shown to correlate positively with serum phosphate levels [41]. Recent study showed that the control of serum phosphate could reduce FGF23 levels [42]. From our results, it showed that CharXgen and AST-120 were capable of binding phosphate in conditions such as in small and the large intestine.…”

Section: Discussionmentioning

confidence: 51%

CharXgen-Activated Bamboo Charcoal Encapsulated in Sodium Alginate Microsphere as the Absorbent of Uremic Toxins to Retard Kidney Function Deterioration

Lin

Sun

et al. 2020

IJMS

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Indoxyl sulphate (IS) and p-cresyl sulphate (PCS) are two protein bound uraemic toxins accumulated in chronic kidney disease (CKD) and associated with adverse outcomes. The purpose of this study isto evaluate the effect of the new activated charcoal, CharXgen, on renal function protection and lowering serum uraemic toxins in CKD animal model. The physical character of CharXgen was analyzed before and after activation procedure by Scanning Electron Microscope (SEM) and X-ray diffractometer (XRD). The effect of CharXgen on biochemistry and lowering uremic toxins was evaluated by in vitro binding assay and CKD animal model. CharXgen have high interior surface area analyzed by SEM and XRD and have been produced from local bamboo after an activation process. CharXgen was able to effectively absorb IS, p-cresol and phosphate in an in vitro gastrointestinal tract simulation study. The animal study showed that CharXgen did not cause intestine blackening. Serum albuminand liver function did not change after feeding with CharXgen. Moreover, renal function was improved in CKD rats fed with CharXgen as compared to the CKD group, and there were no significant differences in the CKD and the CKD + AST-120 groups. Serum IS and PCS were higher in the CKD group and lower in rats treated with CharXgen and AST-120. In rats treated with CharXgen, Fibroblast growth factor 23 was significantly decreased as compared to the CKD group. This change cannot be found in rats fed with AST-120.It indicates that CharXgen is a new safe and non-toxic activated charcoal having potential in attenuating renal function deterioration and lowering protein-bound uraemic toxins. Whether the introduction of this new charcoal could further have renal protection in CKD patients will need to be investigated further.

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“…One notable problem is that some patients were probably in a state of phosphate overload, albeit within normal limits. Fibroblast growth factor 23 (FGF23) is increased in the early stages of CKD, even before phosphate retention occurs, and is more suitable to be considered an indicator of phosphate overload [19]. Thus, further studies including the assessment of FGF23 are needed to evaluate the relationship between serum phosphorus and KSD before optimal reference ranges are developed to guide clinical practice.…”

Section: Homa2-ir (>1)mentioning

confidence: 99%

Sex Differences in Kidney Stone Disease in Chinese Patients with Type 2 Diabetes Mellitus

et al. 2020

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Objectives: To investigate the characteristics of kidney stone disease (KSD) among the Chinese population with type 2 diabetes mellitus (T2DM) and identify sex-specific factors associated with KSD. Methods: A single-center, cross-sectional analysis was performed among Chinese patients with T2DM. KSD was identified by ultrasonography or computed tomography results. Demographic data, physical measurements, laboratory measurements, comorbidities, and related medication data were collected and analyzed. Binary logistic regression was used to explore the associated factors. Results: A total of 7,257 patients with T2DM were included in the study, of which 56.1% were male and 15.0% were diagnosed with KSD. The male-to-female ratio for KSD among T2DM patients was 1.35. Among all the T2DM patients, male gender, HOMA2-IR, uric acid, and renal cysts were independent risk factors for KSD development, whereas serum phosphorus and the use of angiotensin-converting enzyme inhibitors (ACEIs) were independent protective factors for KSD. Among male diabetic patients, triglycerides, HOMA2-IR, renal cysts, and urinary tract infections were all associated with a greater risk of KSD. In contrast, serum phosphorus was associated with a lower risk of KSD. Among female diabetic patients, systolic blood pressure and HOMA2-B were both contributing factors, and ACEIs acted as a protective factor for KSD. Conclusion: Among Chinese patients with T2DM, approximately 1 in 7 patients was affected by KSD, and the prevalence was twice as high as that in the general Chinese population. The factors associated with KSD varied by sex among T2DM patients. Focusing on these factors is beneficial for reducing the risk of KSD and delaying kidney damage in diabetic patients. ease (ESRD) [1]. A review of epidemiological data from seven countries revealed that the prevalence of KSD varied from 1.7% to 14.8% [2]. The health care costs associated with KSD have also increased to more than USD 10 billion in 2006 in the United States [3]. In addition, the disparity in the prevalence of KSD by sex is gradually disappearing, although KSD has historically been twice as common in men than in women. A study in the United States revealed that the male-female ratio of KSD decreased from 1.7 in 1997 to 1.3 in 2002, which might be ascribed to lifestyle changes [4]. A recent study in China reported that the age-and sex-adjusted prevalence of KSD was 5.8% and the male-female ratio was approximately 1.27 (6.5% in men and 5.1% in women) [5]. The reason for the increase in KSD among women is not clearly understood and may partly result from lifestyle and dietary changes and increasing obesity and treatment for stones [3].Diabetes is a common metabolic disease. Type 2 diabetes mellitus (T2DM), which is characterized by insulin resistance (IR), accounts for approximately 90-95% of diabetes cases. The number of people with diabetes worldwide has increased sharply from 108 million in 1980 to 422 million in 2014. The global age-standardized diabetes prevalence has increased from 4....

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Phosphate control in reducing FGF23 levels in hemodialysis patients

Cited by 32 publications

References 57 publications

Fibroblast Growth Factor 23 Trajectories in Chronic Hemodialysis Patients: Lessons from the HEMO Study

Fibroblast Growth Factor 23 Trajectories in Chronic Hemodialysis Patients: Lessons from the HEMO Study

CharXgen-Activated Bamboo Charcoal Encapsulated in Sodium Alginate Microsphere as the Absorbent of Uremic Toxins to Retard Kidney Function Deterioration

Sex Differences in Kidney Stone Disease in Chinese Patients with Type 2 Diabetes Mellitus

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