Early control of PTH and FGF23 in normophosphatemic CKD patients: a new target in CKD-MBD therapy?
OBJECTIVE
Levels of parathyroid hormone (PTH) and the phosphaturic hormone FGF23, a fibroblast growth factor (FGF) family member, increase early in chronic kidney disease (CKD) before the occurrence of hyperphosphatemia. This short-term 6-wk dose titration study evaluated the effect of two phosphate binders on PTH and FGF23 levels in patients with CKD stages 3 to 4.


METHODS
Patients were randomized to receive over a 6-wk period either calcium acetate (n = 19) or sevelamer hydrochloride (n = 21).


RESULTS
At baseline, patients presented with elevated fractional excretion of phosphate, serum PTH, and FGF23. During treatment with both phosphate binders there was a progressive decline in serum PTH and urinary phosphate, but no change in serum calcium or serum phosphate. Significant changes were observed for FGF23 only in sevelamer-treated patients.


CONCLUSIONS
This study confirms the positive effects of early prescription of phosphate binders on PTH control. Prospective and long-term studies are necessary to confirm the effects of sevelamer on serum FGF23 and the benefits of this decrease on outcomes.
Oliveira
Rodrigo B
RB
Nephrology Department, Universidade de São Paulo, São Paulo, Brazil.
Cancela
Ana L E
AL
Graciolli
Fabiana G
FG
Dos Reis
Luciene M
LM
Draibe
Sérgio A
SA
Cuppari
Lilian
L
Carvalho
Aluizio B
AB
Jorgetti
Vanda
V
Canziani
Maria E
ME
Moysés
Rosa M A
RM
D000085:Acetates / Q000627:therapeutic use*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D017610:Calcium Compounds / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010710:Phosphates / Q000097:blood; D010865:Pilot Projects; D011073:Polyamines / Q000627:therapeutic use*; D000069603:Sevelamer; D013997:Time Factors; D016896:Treatment Outcome
D000085:Acetates; D015415:Biomarkers; D017610:Calcium Compounds; D002614:Chelating Agents; C000717427:FGF23 protein, human; C470125:PTH protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D011073:Polyamines; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D000069603:Sevelamer; C120662:calcium acetate