Ohya Masaki, Yashiro Mitsuru, Sonou Tomohiro, Okuda Kouji, Tatsuta Kouichi, Mima Toru, Tone Yoshinori, Negi Shigeo, Saika Yasushi, Shigematsu Takashi
Contrib Nephrol. 2018;196:44-51. doi: 10.1159/000485696. Epub 2018 Jul 24.
Fibroblast growth factor 23 (FGF23) is a regulator of phosphate and vitamin D homeostasis that carries out primary bone- and mineral-related physiological functions to increase renal phosphate excretion and reduce 1α-hydroxylation of 25-hydroxyvitamin D. In a negative endocrine feedback loop, 1,25-dihydroxyvitamin D also stimulates FGF23 secretion. Previous studies have assessed the correlation between vitamin D receptor activator therapy and FGF23 concentrations, and to our knowledge, none has assessed the correlation between intravenous (i.v.) maxacalcitol therapy and FGF23 concentration in hemodialysis patients. Subjects included 148 patients on maintenance hemodialysis. Serum FGF23 concentrations were measured. The correlations among serum FGF23 concentrations with i.v. maxacalcitol therapy and other clinical parameters and medications were analyzed. Mean serum log FGF23 was 3.7 ± 0.8 pg/mL. After division into two equal groups based on median serum log FGF23 level, the percentages of patients administered i.v. maxacalcitol (60/74 [81.1%] vs. 45/74 [60.8%], p < 0.01) were significantly higher in the high log FGF23 group. The amounts of serum FGF23 concentrations had been significantly higher to the amounts of i.v. maxacalcitol per week dependency. Multivariate regression analysis showed that treatment with i.v. maxacalcitol was an independent predictor of serum FGF23 levels, regardless of phosphate or calcium concentrations. i.v. maxacalcitol correlates with serum FGF23 concentration in hemodialysis patients, independent of serum phosphate or calcium concentrations.
成纤维细胞生长因子23（FGF23）是磷酸盐和维生素D稳态的调节因子，执行主要的骨骼和矿物质相关生理功能，以增加肾脏磷酸盐排泄并减少25-羟基维生素D的1α-羟化作用。在负性内分泌反馈回路中，1,25-二羟基维生素D也刺激FGF23分泌。既往研究评估了维生素D受体激活剂治疗与FGF23浓度之间的相关性，据我们所知，尚无研究评估静脉注射（i.v.）马沙骨化醇治疗与血液透析患者FGF23浓度之间的相关性。研究对象包括148例维持性血液透析患者。检测血清FGF23浓度。分析血清FGF23浓度与静脉注射马沙骨化醇治疗以及其他临床参数和药物之间的相关性。血清FGF23对数均值为3.7±0.8 pg/mL。根据血清FGF23对数水平中位数将患者分为两组后，高FGF23对数组接受静脉注射马沙骨化醇的患者百分比显著更高（60/74 [81.1%] 对45/74 [60.8%]，p<0.01）。血清FGF23浓度与每周静脉注射马沙骨化醇的剂量显著相关。多因素回归分析显示，无论磷酸盐或钙浓度如何，静脉注射马沙骨化醇治疗都是血清FGF23水平的独立预测因素。在血液透析患者中，静脉注射马沙骨化醇与血清FGF23浓度相关，独立于血清磷酸盐或钙浓度。
