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Disordered FGF23 and Mineral Metabolism in Children with CKD
- Source :
- Clinical Journal of the American Society of Nephrology. 9:344-353
- Publication Year :
- 2014
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2014.
-
Abstract
- Summary Background and objectives In children with CKD, information is limited regarding the prevalence and determinants of fibroblast growth factor 23 excess and 1,25-dihyroxyvitamin D deficiency across the spectrum of predialysis CKD. This study characterized circulating concentrations of fibroblast growth factor 23 and 1,25-dihyroxyvitamin D, and investigated their interrelationships and associations with GFR and secondary hyperparathyroidism in children with CKD who were enrolled in the Chronic Kidney Disease in Children observational cohort study. Design, setting, participants, & measurements Plasma fibroblast growth factor 23 concentrations and determinants of mineral metabolism were measured in 464 children ages 1–16 years with predialysis CKD. GFR was measured by plasma disappearance of iohexol in 70% of participants and estimated by the Chronic Kidney Disease in Children estimating equation using serum creatinine and cystatin C concentrations in the remainder of the participants. Participants were grouped according to CKD stage and by 10-ml/min categories of GFR. Results Median GFR for the cohort was 45 ml/min per 1.73 m2 (interquartile range=33–57; range=15–109). Plasma fibroblast growth factor 23 concentration was above the normal range in 67% of participants (with higher levels observed among participants with lower GFR) before higher levels of serum parathyroid hormone and phosphorus were observed. Plasma fibroblast growth factor 23 levels were 34% higher in participants with glomerular disease than in participants with nonglomerular disease, despite similar GFR. Serum phosphorus levels, adjusted for age, were significantly lower at GFR of 60–69 ml/min per 1.73 m2 than higher GFR, but thereafter they became higher in parallel with fibroblast growth factor 23 as GFR declined. Serum 1,25-dihyroxyvitamin D concentrations were lower in those participants with low GFR values, high fibroblast growth factor 23 levels, 25-hydroxyvitamin D deficiency, and proteinuria. Secondary hyperparathyroidism was present in 55% of participants with GFR Conclusion In children with predialysis CKD, high plasma fibroblast growth factor 23 is the earliest detectable abnormality in mineral metabolism, and levels are highest in glomerular diseases.
- Subjects :
- Fibroblast growth factor 23
Epidemiology
Kidney
urologic and male genital diseases
Critical Care and Intensive Care Medicine
Severity of Illness Index
chemistry.chemical_compound
Vitamin D
Child
Age Factors
Phosphorus
female genital diseases and pregnancy complications
Parathyroid Hormone
Nephrology
Child, Preschool
Creatinine
Secondary hyperparathyroidism
Glomerular Filtration Rate
Canada
medicine.medical_specialty
Adolescent
Renal function
vitamin D deficiency
Predictive Value of Tests
Internal medicine
Vitamin D and neurology
medicine
Humans
Cystatin C
Renal Insufficiency, Chronic
Transplantation
Hyperparathyroidism
business.industry
Infant
Original Articles
Vitamin D Deficiency
medicine.disease
United States
Fibroblast Growth Factors
Fibroblast Growth Factor-23
Cross-Sectional Studies
Early Diagnosis
Endocrinology
chemistry
Calcium
Hyperparathyroidism, Secondary
business
Biomarkers
Kidney disease
Subjects
Details
- ISSN :
- 15559041
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Clinical Journal of the American Society of Nephrology
- Accession number :
- edsair.doi.dedup.....e8ea77e7a5524563cb112a41d31a50b7