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Cited by 9Parathyroid Disorders and TreatmentsDialysis and Renal Disease ManagementPotassium and Related Disorders

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Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients

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Egli-Spichtig, Daniela, Hamid, Ahmad Kamal, Arroyo, Eva Maria Pastor, Ketteler, Markus, Wiecek, Andrzej, Rosenkranz, Alexander R, Pasch, Andreas, Lorenz, Horst, Hellmann, Burkhard, Karus, Michael, Ammer, Richard, Rubio-Aliaga, Isabel, Wagner, Carsten A·2023·Clinical Kidney Journal
DOI 10.1093/ckj/sfad040PMC PMC10539220
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Abstract

Background: Hyperphosphatemia is associated with increased mortality and cardiovascular morbidity of end-stage kidney failure (ESKF) patients. Managing serum phosphate in ESKF patients is challenging and mostly based on limiting intestinal phosphate absorption with low phosphate diets and phosphate binders (PB). In a multi-centric, double-blinded, placebo-controlled study cohort of maintenance hemodialysis patients with hyperphosphatemia, we demonstrated the efficacy of nicotinamide modified release (NAMR) formulation treatment in addition to standard PB therapy in decreasing serum phosphate. Here we aimed to assess the relationship between phosphate, FGF23, inflammation and iron metabolism in this cohort. Methods: We measured the plasma concentrations of intact fibroblast growth factor 23 (iFGF23) and selected proinflammatory cytokines at baseline and Week 12 after initiating treatment. Results: We observed a strong correlation between iFGF23 and cFGF23 (C-terminal fragment plus iFGF23). We identified iFGF23 as a better predictor of changes in serum phosphate induced by NAMR and PB treatment compared with cFGF23. Recursive partitioning revealed at baseline and Week 12, that iFGF23 and cFGF23 together with T50 propensity were the most important predictors of serum phosphate, whereas intact parathyroid hormone (iPTH) played a minor role in this model. Furthermore, we found serum phosphate and iPTH as the best predictors of iFGF23 and cFGF23. Sex, age, body mass index, and markers of inflammation and iron metabolism had only a minor impact in predicting FGF23. Conclusion: Lowering serum phosphate in ESKF patients may depend highly on iFGF23 which is correlated to cFGF23 levels. Serum phosphate was the most important predictor of plasma FGF23 in this ESKF cohort.

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Metadata

Authors
Egli-Spichtig, D., Hamid, A. K., Arroyo, E. M. P., Ketteler, M., Wiecek, A., Rosenkranz, A. R., Pasch, A., Lorenz, H., Hellmann, B., Karus, M., Ammer, R., Rubio-Aliaga, I., & Wagner, C. A.
Affiliations
  • University of Zurich (CH)
  • Robert Bosch Hospital (DE)
  • Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice , Poland
  • Medical University of Graz (AT)
  • Johannes Kepler University of Linz (AT)
  • Buero fuer Biometrie und Statistik , Neuberg, Germany
  • Medice (Germany) (DE)
  • University Hospital Münster (DE)
  • Institute of Physiology, University of Zurich , 8057 Zurich , Switzerland ,
Corresponding author
Wagner, Carsten A
ORCID
Venue
Clinical Kidney Journal
Publisher
Oxford University Press (OUP)
Published
2023-03-10
Volume
16
Issue
10
Pages
1622-1633
ISSN
  • 2048-8505 (ISSN-L)
  • 2048-8513
DOI
10.1093/ckj/sfad040
PMC
PMC10539220
OpenAlex
W4323921881
Cited by
9
References
1
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2023: 2
FWCI
1.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Kidney Journal (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by-nc-nd)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
Swiss National Science Foundation (212303)
Topics
  • Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Nephrology › Potassium and Related Disorders
Keywords
intact FGF23, C-terminal FGF23, serum phosphorus, hyperphosphatemia, phosphate binders, hemodialysis, end-stage kidney failure, parathyroid hormone, inflammation, iron metabolism, inflammatory cytokines

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