High serum phosphorus and FGF 23 levels are associated with progression of coronary calcifications.
BACKGROUND
Coronary calcifications (CC) portend increased mortality in adults receiving hemodialysis (HD), however the risk factors associated with CC progression are not well known in pediatric patients. Our previous cross-sectional studies demonstrated high CC prevalence (31 %) in pediatric patients, which were significantly associated with high serum phosphorus (P), fibroblast growth factor 23 (FGF) levels, dialysis vintage, and low cholesterol. The current study was undertaken to determine and elucidate CC progression in pediatric HD patients.


METHODS
A 1-year prospective longitudinal study of 16 pediatric patients (ten male; mean age, 16.9 ± 3 years; range, 10.1-20.4 years) receiving chronic HD was conducted.


RESULTS
CC were observed in five of 16 (31.3 %) patients on baseline computed tomogram (CT) scan; 14/16 patients underwent 1-year CT. All patients with initial CC who completed CT at 1 year (3/5) progressed; one patient had new CC and none of the patients had resolved CC. Mean Agatston score increased from 23.4 ± 18.06 HU (baseline) to 169 ± 298.9 HU. Patients with CC progression had higher mean serum P (8.6 ± 1.8 mg/dl vs. 6.3 ± 1.1 mg/dl, p = 0.015) and FGF 23 levels (3,994 ± 860.5 pg/ml vs. 2,327 ± 1,206.4 pg/ml, p = 0.028). Serum P and FGF 23 levels were positively correlated with final Agatston scores (R = 0.65, p = 0.01 for serum P and R = 0.54, p = 0.045 for FGF 23) and change in Agatston scores (R = 0.65, p = 0.01 for serum P and R = 0.52, p = 0.048 for FGF 23).


CONCLUSIONS
Our study shows that CC is progressive in pediatric patients receiving HD and that increased serum P and FGF 23 levels are associated with this progression.
Texas Children's Hospital-Pediatric Nephrology, Baylor College of Medicine, 6621 Fannin Street, MC 3-2482, Houston, TX, 77030, USA, srivaths@bcm.edu.
Poyyapakkam R
PR
Srivaths
Stuart L
SL
Goldstein
Rajesh
R
Krishnamurthy
Douglas M
DM
Silverstein
D000293:Adolescent; D002114:Calcinosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D009202:Cardiomyopathies / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D002648:Child; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010758:Phosphorus / Q000097:blood*; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
C000717427:FGF23 protein, human; D010758:Phosphorus; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23