Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
1] Department of Renal Medicine, Royal Derby Hospital, Derby, UK [2] Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK.
Kidney Int. 2014 Aug;86(2):407-13. doi: 10.1038/ki.2013.537. Epub 2014 Jan 15.
Fibroblast growth factor (FGF) 23 is an important regulator of phosphaturia. Its serum level was found to increase before that of parathyroid hormone (PTH) in early chronic kidney disease (CKD) in some but not all previous studies. As vitamin D insufficiency is associated with elevated PTH, we determined the effect of vitamin D status on FGF23 and PTH levels in relation to glomerular filtration rate (GFR) in people with CKD stage 3. Serum intact FGF23, PTH, and 25(OH)vitamin D3 were measured in 1664 patients who were prospectively recruited from primary care. Mean or median values for key variables were an age of 73 years, estimated GFR (eGFR) of 53 ml/min per 1.73 m(2), PTH 46 pg/ml, FGF23 42 pg/ml, and 25(OH)vitamin D3 53 nmol/l. FGF23 and PTH concentrations were elevated in similar proportions of people with lower eGFR in the whole cohort. However, when 752 people with vitamin D insufficiency or deficiency were excluded, FGF23 was elevated in a greater proportion than PTH at all levels of eGFR. Conversely, among people with vitamin D insufficiency, PTH was elevated in a greater proportion than FGF23 at all GFR levels of ⩾40 ml/min per 1.73 m(2). In this cohort, we were able to triangulate the relationship between 25(OH)vitamin D3, PTH, and FGF23, showing that vitamin D status critically determines whether FGF23 or PTH becomes elevated first in the context of lower GFR. Future studies of FGF23 in people with CKD should routinely determine their vitamin D status.
成纤维细胞生长因子 23（FGF23）是尿磷排泄的重要调节因子。在一些但并非所有先前的研究中发现，在早期慢性肾脏病（CKD）中，其血清水平在甲状旁腺激素（PTH）之前升高。由于维生素 D 不足与 PTH 升高有关，我们确定了维生素 D 状态对肾小球滤过率（GFR）下降的 CKD 3 期患者的 FGF23 和 PTH 水平的影响。前瞻性地从初级保健中招募了 1664 名患者，检测其血清完整 FGF23、PTH 和 25（OH）维生素 D3。主要变量的平均值或中位数为年龄 73 岁，估计肾小球滤过率（eGFR）为 53ml/min/1.73m2，PTH 为 46pg/ml，FGF23 为 42pg/ml，25（OH）维生素 D3 为 53nmol/L。在整个队列中，eGFR 较低的人群中，FGF23 和 PTH 浓度升高的比例相似。然而，当排除 752 名维生素 D 不足或缺乏的患者时，在所有 eGFR 水平下，FGF23 升高的比例大于 PTH。相反，在维生素 D 不足的人群中，在所有 GFR 水平（≥40ml/min/1.73m2）下，PTH 升高的比例大于 FGF23。在该队列中，我们能够对 25（OH）维生素 D3、PTH 和 FGF23 之间的关系进行三角剖分，表明维生素 D 状态在 GFR 下降的情况下，对 FGF23 或 PTH 哪个先升高具有决定性作用。今后在 CKD 患者中进行 FGF23 的研究应常规确定其维生素 D 状态。
