Clinical relevance of FGF-23 in chronic kidney disease.
Fibroblast growth factor (FGF)-23 is a recently discovered regulator of calcium-phosphate metabolism. Whereas other known FGFs mainly act in a paracrine manner, FGF-23 has significant systemic effects. Together with its cofactor Klotho, FGF-23 enhances renal phosphate excretion in order to maintain serum phosphate levels within the normal range. In patients with chronic kidney disease (CKD), FGF-23 levels rise in parallel with declining renal function long before a significant increase in serum phosphate concentration can be detected. However, in cross-sectional studies increased FGF-23 levels in patients with CKD were found to be associated not only with therapy-resistant secondary hyperparathyroidism but were also independently related to myocardial hypertrophy and endothelial dysfunction after adjustment for traditional markers of calcium-phosphate metabolism. Finally, in prospective studies high serum FGF-23 concentrations predicted faster disease progression in CKD patients not on dialysis, and increased mortality in patients receiving maintenance hemodialysis. FGF-23 may therefore prove to be an important therapeutic target in the management of CKD.
Seiler
Sarah
S
Department of Internal Medicine IV-Renal and Hypertensive Disease, Saarland University Medical Centre, Homburg/Saar, Germany.
Heine
Gunnar H
GH
Fliser
Danilo
D
D002117:Calcitriol / Q000097:blood; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000502:physiology*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000097:blood*; D016030:Kidney Transplantation / Q000502:physiology; D010281:Parathyroid Hormone / Q000502:physiology; D010710:Phosphates / Q000097:blood / Q000652:urine; D006435:Renal Dialysis / Q000401:mortality
C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002117:Calcitriol