title: Phosphate and FGF-23 homeostasis after kidney transplantation.
abstract: Dysregulated phosphate metabolism is a common consequence of chronic kidney disease, and is characterized by a high circulating level of fibroblast growth factor (FGF)-23, hyperparathyroidism, and hyperphosphataemia. Kidney transplantation can elicit specific alterations to phosphate metabolism that evolve over time, ranging from severe hypophosphataemia (<0.5 mmol/l) to hyperphosphataemia (>1.50 mmol/l) and high FGF-23 levels. The majority of renal transplant recipients develop hypophosphataemia during the first 3 months after transplantation as a consequence of relatively slow adaptation of FGF-23 and parathyroid hormone levels to restored renal function, and the influence of immunosuppressive drugs. By 3-12 months after transplantation, phosphate homeostasis is at least partially restored in the majority of recipients, which is paralleled by a substantially reduced risk of cardiovascular-associated morbidity and mortality compared with the pre-transplantation setting. Many renal transplant recipients, however, exhibit persistent abnormalities in phosphate homeostasis, which is often due to multifactorial causes, and may contribute to adverse outcomes on the cardiovascular system, kidney, and bone. Dietary and pharmacologic interventions might improve phosphate homeostasis in renal transplant recipients, but additional insight into the pathophysiology of transplantation-associated abnormalities in phosphate homeostasis is needed to further optimize disease management and improve prognosis for renal transplant recipients.
authors.affiliation: Division of Nephrology, Department of Medicine, Universidade Federal de São Paulo, Rua Botucatu 740-Vila Clementino, São Paulo, SP 04023 900, Brazil.
authors.forename: Leandro C
authors.initials: LC
authors.lastname: Baia
authors.affiliation: Division of Nephrology, Department of Medicine, Universidade Federal de São Paulo, Rua Botucatu 740-Vila Clementino, São Paulo, SP 04023 900, Brazil.
authors.forename: Ita Pfeferman
authors.initials: IP
authors.lastname: Heilberg
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, Netherlands.
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, Netherlands.
authors.forename: Martin H
authors.initials: MH
authors.lastname: de Borst
mesh_terms: D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000502:physiology*; D006706:Homeostasis; D006801:Humans; D016030:Kidney Transplantation; D010710:Phosphates / Q000502:physiology*
chemical_list: C000717427:FGF23 protein, human; D010710:Phosphates; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23