Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 RAMA IV, Bangkok, 10330, Thailand.
Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Int Urol Nephrol. 2022 Feb;54(2):309-321. doi: 10.1007/s11255-021-02848-0. Epub 2021 Apr 2.
The heightened fibroblast growth factor 23 (FGF23) level in patients with chronic kidney disease (CKD) is associated with increased cardiovascular disease and mortality. We performed a systematic review and meta-analysis to synthesize the available strategies to reduce FGF23 in CKD patients.
We conducted a meta-analysis by searching the databases of MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) and single-arm studies that examined the effects of dietary phosphate restriction, phosphate binders, iron supplements, calcimimetics, parathyroidectomy, dialysis techniques, and the outcome of preservation of residual renal function (RRF) on FGF23 levels in CKD patients. Random-effects model meta-analyses were used to compute changes in the outcome of interests.
A total of 41 articles (7590 patients), comprising 36 RCTs, 5 prospective studies were included in this meta-analysis. Dietary phosphate restriction less than 800 mg per day yielded insignificant effect on FGF23 reduction. Interestingly sevelamer, lanthanum, iron-based phosphate binders, and iron supplement significantly lowered FGF23 levels. In CKD patients with secondary hyperparathyroidism, calcimimetics prescription could significantly reduce FGF23 levels, while surgical parathyroidectomy had no significant effect. In dialysis patients, preservation of RRF and hemoperfusion as well as hemodiafiltration provided a significant decrease in FGF23 levels.
The present meta-analysis demonstrated that non-calcium-based phosphate binders including sevelamer, lanthanum, and iron-based phosphate binders, iron supplements, calcimimetics, hemoperfusion, and preservation of RRF could effectively reduce FGF23 in CKD patients.
慢性肾脏病（CKD）患者的成纤维细胞生长因子 23（FGF23）水平升高与心血管疾病和死亡率增加有关。我们进行了系统评价和荟萃分析，以综合现有的降低 CKD 患者 FGF23 的策略。
我们通过搜索 MEDLINE、Scopus 和 Cochrane 对照试验中心注册数据库，对评估饮食磷酸盐限制、磷酸盐结合剂、铁补充剂、钙敏感受体激动剂、甲状旁腺切除术、透析技术以及保留残余肾功能（RRF）对 CKD 患者 FGF23 水平影响的随机对照试验（RCT）和单臂研究进行了荟萃分析。使用随机效应模型荟萃分析计算感兴趣结局的变化。
共有 41 篇文章（7590 名患者），包括 36 项 RCT 和 5 项前瞻性研究，纳入了本荟萃分析。每天少于 800mg 的饮食磷酸盐限制对 FGF23 减少没有显著效果。有趣的是，司维拉姆、镧、铁基磷酸盐结合剂和铁补充剂可显著降低 FGF23 水平。在继发性甲状旁腺功能亢进的 CKD 患者中，钙敏感受体激动剂的处方可以显著降低 FGF23 水平，而甲状旁腺切除术则没有显著效果。在透析患者中，RRF 的保留和血液灌流以及血液透析滤过可显著降低 FGF23 水平。
本荟萃分析表明，非钙基磷酸盐结合剂包括司维拉姆、镧和铁基磷酸盐结合剂、铁补充剂、钙敏感受体激动剂、血液灌流和保留 RRF 可有效降低 CKD 患者的 FGF23。
