Department of Paediatric Nephrology, Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK.
Nephrol Dial Transplant. 2012 Dec;27(12):4361-8. doi: 10.1093/ndt/gfs109. Epub 2012 Apr 23.
The aims of our study were to investigate (i) the prevalence of elevated fibroblast growth factor-23 (FGF-23), (ii) the relationship between FGF-23 concentrations and level of renal dysfunction and (iii) the main determinants of elevation of FGF-23 concentration in children with pre-dialysis chronic kidney disease (CKD) Stages 3-5.
In this single-centre prospective observational study, 71 children with pre-dialysis CKD Stages 3-5, aged 11.9 ± 3.1 years, had FGF-23 levels measured. Anthropometry and routine laboratory investigations were measured.
Fourteen (19.7%) patients had normal FGF-23 concentrations defined as < 50 ng/L. FGF-23 [median (interquartile range)] concentrations were 78.7 (55.6-137.6) ng/L and following log transformation normalized data with log FGF-23 [mean (SD)] values of 1.96 ± 0.4 ng/L. Log FGF-23 concentrations had a negative reciprocal relationship with estimated glomerular filtration rate (eGFR) (P < 0.0001) and 1,25 vitamin D3 levels (P = 0.01) and a positive relationship with phosphate (P = 0.03) and percent fractional excretion of phosphate (P = 0.01) but not with log-intact parathyroid hormone (PTH) (P = 0.22). Multiple linear regression demonstrated a strong relationship between log FGF-23 and eGFR only.
Elevated FGF-23 concentrations were observed in the majority of a carefully managed cohort of children with non-dialysis CKD with a dominant effect on FGF-23 concentrations with glomerular filtration rate (GFR). These data allow the potential confounding effects of PTH and phosphate elevation with declining GFR to be removed, leaving a clearer picture of the FGF-23-GFR relationship.
我们研究的目的是调查(i)成纤维细胞生长因子 23（FGF-23）升高的患病率，(ii)FGF-23 浓度与肾功能水平的关系，以及(iii)透析前慢性肾脏病（CKD）3-5 期儿童 FGF-23 浓度升高的主要决定因素。
在这项单中心前瞻性观察研究中，测量了 71 名透析前 CKD 3-5 期的儿童的 FGF-23 水平。测量了人体测量学和常规实验室检查。
14 名（19.7%）患者的 FGF-23 浓度正常，定义为<50ng/L。FGF-23[中位数（四分位距）]浓度为 78.7（55.6-137.6）ng/L，经对数转换后，log FGF-23[平均值（SD）]值为 1.96±0.4ng/L。log FGF-23 浓度与估算肾小球滤过率（eGFR）呈负倒数关系（P<0.0001），与 1,25 维生素 D3 水平呈正相关（P=0.01），与磷酸盐呈正相关（P=0.03），与磷酸盐的分数排泄率呈正相关（P=0.01），但与 log 完整甲状旁腺激素（PTH）无关（P=0.22）。多元线性回归显示，log FGF-23 与 eGFR 之间存在很强的关系。
在精心管理的非透析 CKD 儿童队列中，大多数儿童的 FGF-23 浓度升高，FGF-23 浓度与肾小球滤过率（GFR）有主要影响。这些数据可以消除 PTH 和磷酸盐升高与 GFR 下降的潜在混杂影响，更清晰地显示 FGF-23-GFR 关系。
