title: Lanthanum carbonate reduces FGF23 in chronic kidney disease Stage 3 patients.
abstract: BACKGROUND
  In chronic kidney disease (CKD) patients, the ability to excrete a phosphate load is impaired. Compensatory increase in parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) promote phosphaturia. Serum FGF23 concentration is considered an early biomarker of excess phosphate load and high levels of FGF23 have been associated with increased mortality. In the present study, we have evaluated the changes in plasma FGF23 after treatment with the phosphate binder lanthanum carbonate in patients with CKD-3 and a normal serum phosphate concentration.
  
  
  METHODS
  Eighteen Caucasian CKD Stage 3a/3b patients with serum phosphate <4.5 mg/dL were recruited in a prospective longitudinal open-label study. Patients received a 4-week period of standardized phosphorus-restricted diet containing 0.8 g/Kg/day protein. Thereafter, the same diet was maintained and patients received lanthanum carbonate (750 mg with the three main meals) for 4 weeks.
  
  
  RESULTS
  No significant changes were observed in serum phosphate, however, lanthanum carbonate significantly decreased urinary excretion of phosphate and fractional excretion of phosphate (P < 0.004). This was accompanied by a significant decrease in carboxyterminal FGF23 (median percent change from baseline -21.8% (interquartile range -4.5, -30%), P = 0.025). No changes were observed in PTH.
  
  
  CONCLUSIONS
  In conclusion, lanthanum carbonate reduced phosphate load, as assessed by urinary phosphate excretion, and also reduced plasma FGF23 in CKD-3 patients. This occurs in the presence of unchanged normal serum phosphate levels.
authors: IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain. egonzalezpa@senefro.org
authors: Emilio
authors: E
authors: Gonzalez-Parra
authors: Maria Luisa
authors: ML
authors: Gonzalez-Casaus
authors: Antonio
authors: A
authors: Galán
authors: Alberto
authors: A
authors: Martinez-Calero
authors: Victor
authors: V
authors: Navas
authors: Mariano
authors: M
authors: Rodriguez
authors: Alberto
authors: A
authors: Ortiz
mesh_terms: D000368:Aged; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D007811:Lanthanum / Q000494:pharmacology*; D008137:Longitudinal Studies; D008297:Male; D010758:Phosphorus / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: C000717427:FGF23 protein, human; D010758:Phosphorus; C119467:lanthanum carbonate; D005346:Fibroblast Growth Factors; D007811:Lanthanum; D000089703:Fibroblast Growth Factor-23