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The effect of interactions between proteinuria, activity of fibroblast growth factor 23 and serum phosphate on renal progression in patients with chronic kidney disease: a result from the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease study

Authors
 Hyoungnae Kim  ;  Jimin Park  ;  Ki Heon Nam  ;  Jong Hyun Jhee  ;  Hae-Ryong Yun  ;  Jung Tak Park  ;  Seung Hyeok Han  ;  Wookyung Chung  ;  Kook-Hwan Oh  ;  Sue Kyung Park  ;  Soo Wan Kim  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Curie Ahn  ;  Tae-Hyun Yoo 
Citation
 NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol.35(3) : 438-446, 2020-03 
Journal Title
 NEPHROLOGY DIALYSIS TRANSPLANTATION 
ISSN
 0931-0509 
Issue Date
2020-03
Keywords
FGF-23 ; chronic kidney disease ; phosphate ; prognosis ; proteinuria
Abstract
Background: Recent experimental study reported that proteinuria increases serum phosphate by decreasing biologic activity of fibroblast growth factor 23 (FGF-23). We examined this relationship in a large chronic kidney disease (CKD) cohort and evaluated the combined effect of proteinuria, FGF-23 activity and serum phosphate on CKD progression. Methods: The activity of FGF-23, measured by the fractional excretion of phosphate (FEP)/FGF-23 ratio, was compared according to the degree of proteinuria in 1909 patients with CKD. Primary outcome was CKD progression defined as ≥50% decline of estimated glomerular filtration rate, doubling of serum creatinine and start of dialysis. Results: There was a negative relationship between 24-h urine protein (24-h UP) and FEP/FGF-23 ratio (γ -0.07; P = 0.005). In addition, after matching variables associated with serum phosphate, patients with more proteinuria had higher serum phosphate (P < 0.001) and FGF-23 (P = 0.012), and lower FEP/FGF-23 ratio (P = 0.007) compared with those with less proteinuria. In the matched cohort, low FEP/FGF-23 ratio was an independent risk factor for CKD progression (hazard ratio 0.87 per 1 log increase; 95% confidence interval 0.79-0.95; P = 0.002), and there was significant interaction between 24-h UP and FEP/FGF-23 ratio (P = 0.039). Furthermore, 24-h UP and serum phosphate also had a significant interaction on CKD progression (P < 0.001). Conclusions: Proteinuria is associated with decreased biologic activity of FGF-23 and increased serum phosphate. Furthermore, diminished activity of FGF23 is an independent risk factor for renal progression in proteinuric CKD patients.
Full Text
https://academic.oup.com/ndt/article/35/3/438/5273282
DOI
10.1093/ndt/gfy403
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Nam, Ki Heon(남기헌) ORCID logo https://orcid.org/0000-0001-7312-7027
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Jhee, Jong Hyun(지종현)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/179084
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