Pathophysiology Unit, Department of Pathophysiology, Medical University of Silesia, Katowice, Poland Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland.
Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical University of Silesia, Katowice, Poland.
Nephrol Dial Transplant. 2014 Sep;29(9):1757-63. doi: 10.1093/ndt/gfu063. Epub 2014 Apr 11.
Better biomarkers of CKD reflecting responses to decreased glomerular filtration rate (GFR) are needed. We determined the value of estimated GFR (eGFR) as a threshold for the increase of plasma cFGF23 (C-terminal) and intact fibroblast growth factor-23 (iFGF23) (intact) concentrations in the course of chronic kidney disease (CKD) and compared this eGFR value with values related to increased serum intact parathyroid hormone (iPTH) or phosphorus concentrations in an elderly population.
We measured plasma iFGF23, cFGF23, serum phosphorus, calcium, albumin, creatinine, urea, cystatin C, iPTH and vitamin 25-OH-D3 in 3780 population-based study participants aged ≥ 65 years.
Serum phosphorus concentrations hardly increased until mean eGFR reached 47.3 ± 4.7 mL/min/1.73 m(2) but then increased exponentially. Similarly, both iPTH and iFGF23 increased slightly in early CKD but then increased exponentially when eGFR reached 55.0 ± 4.2 mL/min/1.73 m(2) for iPTH and 51.6 ± 5.7 mL/min/1.73 m(2) for iFGF23. The departure point for exponential increases in cFGF23 preceded those for iPTH and iFGF23 and occurred at a mean eGFR of 57.7 ± 7.8 mL/min/1.73 m(2). The prevalence of increased iFGF23 occurred at a remarkably higher eGFR value than that of cFGF23 across the CKD stages.
The increase in cFGF23 preceded both the increase in iPTH and iFGF23 as eGFR declined. Increased plasma iFGF23 level did not precede the rise in serum iPTH concentrations and did not occur before stage-3 CKD in elderly persons. However, cFGF23 was not an early marker of CKD in the elderly subjects.
需要更好的 CKD 生物标志物来反映肾小球滤过率（GFR）的下降。我们确定了估算的 GFR（eGFR）作为血浆 cFGF23（C 端）和完整成纤维细胞生长因子 23（iFGF23）（完整）浓度在慢性肾脏病（CKD）过程中增加的阈值，并将该 eGFR 值与与老年人群中血清完整甲状旁腺激素（iPTH）或磷浓度升高相关的值进行了比较。
我们测量了 3780 名年龄≥65 岁的基于人群的研究参与者的血浆 iFGF23、cFGF23、血清磷、钙、白蛋白、肌酐、尿素、胱抑素 C、iPTH 和维生素 25-OH-D3。
血清磷浓度直到平均 eGFR 达到 47.3±4.7mL/min/1.73m²时才几乎增加，但随后呈指数增加。同样，iPTH 和 iFGF23 在早期 CKD 中仅略有增加，但当 eGFR 达到 55.0±4.2mL/min/1.73m²时，iPTH 和 51.6±5.7mL/min/1.73m²时，iFGF23 呈指数增加。cFGF23 指数增加的起始点早于 iPTH 和 iFGF23 的增加，发生在平均 eGFR 为 57.7±7.8mL/min/1.73m²时。与 CKD 各阶段相比，iFGF23 增加的患病率出现在显著更高的 eGFR 值。
随着 eGFR 的下降，cFGF23 的增加先于 iPTH 和 iFGF23 的增加。血浆 iFGF23 水平的增加并不先于血清 iPTH 浓度的升高，也不在老年人的 CKD 第 3 阶段之前发生。然而，cFGF23 并不是老年人 CKD 的早期标志物。
