Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Kidney Int. 2011 Jun;79(12):1370-8. doi: 10.1038/ki.2011.47. Epub 2011 Mar 9.
Fibroblast growth factor 23 (FGF23) regulates phosphorus metabolism and is a strong predictor of mortality in dialysis patients. FGF23 is thought to be an early biomarker of disordered phosphorus metabolism in the initial stages of chronic kidney disease (CKD). We measured FGF23 in baseline samples from 3879 patients in the Chronic Renal Insufficiency Cohort study, which is a diverse cohort of patients with CKD stage 2-4. Mean serum phosphate and median parathyroid hormone (PTH) levels were in the normal range, but median FGF23 was markedly greater than in healthy populations, and increased significantly with decreasing estimated glomerular filtration rate (eGFR). High levels of FGF23, defined as being above 100 RU/ml, were more common than secondary hyperparathyroidism and hyperphosphatemia in all strata of eGFR. The threshold of eGFR at which the slope of FGF23 increased was significantly higher than the corresponding threshold for PTH based on non-overlapping 95% confidence intervals. Thus, increased FGF23 is a common manifestation of CKD that develops earlier than increased phosphate or PTH. Hence, FGF23 measurements may be a sensitive early biomarker of disordered phosphorus metabolism in patients with CKD and normal serum phosphate levels.
成纤维细胞生长因子 23（FGF23）调节磷代谢，是透析患者死亡率的强预测因子。FGF23 被认为是慢性肾脏病（CKD）早期阶段磷代谢紊乱的早期生物标志物。我们在慢性肾功能不全队列研究（Chronic Renal Insufficiency Cohort study）的 3879 名患者的基线样本中测量了 FGF23，该研究是一个由 CKD 2-4 期患者组成的多样化队列。血清磷酸盐的平均水平和甲状旁腺激素（PTH）的中位数水平处于正常范围，但中位数 FGF23 明显高于健康人群，并且随着估计肾小球滤过率（eGFR）的降低而显著增加。高水平的 FGF23（定义为超过 100 RU/ml）在所有 eGFR 分层中比继发性甲状旁腺功能亢进症和高磷血症更为常见。FGF23 斜率增加的 eGFR 阈值明显高于基于不重叠 95%置信区间的 PTH 相应阈值。因此，增加的 FGF23 是 CKD 的常见表现，比增加的磷酸盐或 PTH 更早出现。因此，FGF23 测量可能是 CKD 患者磷代谢紊乱的敏感早期生物标志物，且血清磷酸盐水平正常。
