title: Lower serum fibroblast growth factor-23 levels may suggest malnutrition in maintenance haemodialysis patients.
abstract: OBJECTIVE
  It is reported that high serum fibroblast growth factor-23 (FGF-23) levels are associated with increased mortality in haemodialysis patients, and can be caused by hyperphosphataemia and loss of residual renal function. However, hypophosphataemia is also associated with increased mortality in maintenance haemodialysis (MHD) patients. We studied the determinants of the serum FGF-23 levels in MHD patients, focusing on nutritional status and residual renal function.
  
  
  METHODS
  A total of 332 Japanese MHD patients with a median age of 69 years, and median dialysis vintage of 66 months, were studied. The serum levels of intact FGF-23, albumin, phosphate, and intact parathyroid hormone (iPTH), corrected serum calcium (Ca) levels, urine volume, (creatinine clearance+urea clearance)/2, phosphate clearance, Kt/Vurea, body mass index (BMI), normalized protein catabolic rate (nPCR), normalized protein equivalent of nitrogen appearance (nPNA), geriatric nutritional risk index (GNRI), and the prescribed dosages of active vitamin D and phosphate binders were assessed.
  
  
  RESULTS
  The significant independent factors for InFGF-23 by multivariate analysis were age, GNRI, serum phosphate, Ca, iPTH levels and dosage of active vitamin D in patients without residual renal function (P<0.05). Among all MHD patients, the lowest BMI, nPNA, nPCR, GNRI, serum albumin, creatinine, phosphate, Ca, Ca x P product and iPTH values were seen in the lowest serum FGF-23 quartile (FGF-23<311 pg/mL).
  
  
  CONCLUSIONS
  The determinants of the serum FGF-23 level in MHD patients without residual renal function were age, serum phosphate, Ca, iPTH levels, the active vitamin D dose and the GNRI. The lower serum FGF-23 levels may suggest malnutrition in MHD patients.
authors.affiliation: Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan.
authors.forename: Sonoo
authors.initials: S
authors.lastname: Mizuiri
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nishizawa
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Kyoka
authors.initials: K
authors.lastname: Ono
authors.forename: Maya
authors.initials: M
authors.lastname: Oda
authors.forename: Kohji
authors.initials: K
authors.lastname: Usui
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Shigemoto
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D002614:Chelating Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D015536:Down-Regulation; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D015577:Geriatric Assessment; D006801:Humans; D007564:Japan; D007668:Kidney / Q000503:physiopathology; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; C000717427:FGF23 protein, human; C470125:PTH protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002118:Calcium
keywords: fibroblast growth factor-23; hyperphosphataemia; hypophosphataemia; maintenance haemodialysis patients; malnutrition; residual renal function