Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Am J Nephrol. 2013;37(5):462-71. doi: 10.1159/000350537. Epub 2013 Apr 27.
BACKGROUND/AIMS: Treatment strategies for abnormal mineral metabolism in chronic kidney disease are largely based on achieving target ranges of biomarkers that vary considerably over time, yet determinants of their variability are poorly defined.
Observational study including 162 patients of three dialysis cohorts (peritoneal dialysis, n = 78; hemodialysis, n = 49; hemodiafiltration, n = 35). Clinical and biochemical determinants of parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23) variability were analyzed in the peritoneal dialysis cohort. All cohorts were used for comparison of PTH and FGF23 intra-subject variability (intra-class correlation), and their intra-subject variability in different modes of dialysis was explored.
High PTH variability was independently associated with lower 25-hydroxyvitamin D concentration and factors of lipid and glucose metabolism, whereas high FGF23 variability was mainly associated with lower baseline serum phosphorous. These results were consistent in multivariate and sensitivity analyses. The intra-subject variability of FGF23 was lower than for PTH irrespective of dialysis mode.
Baseline vitamin D status and serum phosphorous are independent determinants of the longitudinal variation in PTH and FGF23, respectively. The clinical utility of FGF23 measurement remains unknown, yet it appears favorable based on its greater temporal stability than PTH in dialysis patients.
背景/目的：慢性肾脏病患者异常矿物质代谢的治疗策略主要基于实现生物标志物的目标范围，这些标志物在时间上有很大的差异，但它们的变异决定因素尚未明确。
本研究包括三个透析队列（腹膜透析、血液透析和血液透析滤过）的 162 名患者。分析了腹膜透析队列中甲状旁腺激素（PTH）和成纤维细胞生长因子 23（FGF23）变异性的临床和生化决定因素。所有队列均用于比较 PTH 和 FGF23 的个体内变异性（组内相关系数），并探讨了它们在不同透析模式下的个体内变异性。
高 PTH 变异性与较低的 25-羟维生素 D 浓度以及脂质和糖代谢的因素独立相关，而高 FGF23 变异性主要与较低的基线血清磷有关。这些结果在多变量和敏感性分析中是一致的。无论透析模式如何，FGF23 的个体内变异性均低于 PTH。
基线维生素 D 状态和血清磷分别是 PTH 和 FGF23 纵向变化的独立决定因素。FGF23 测量的临床实用性尚不清楚，但鉴于其在透析患者中的时间稳定性优于 PTH，因此似乎具有优势。
