Intensive Phosphate Control May Reduce FGF23 in HD

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A serum phosphate control target of 4.5 mg/dL or below in hemodialysis patients was accompanied by a decline in fibroblast growth factor 23.
A serum phosphate control target of 4.5 mg/dL or below in hemodialysis patients was accompanied by a decline in fibroblast growth factor 23.
The following article is part of conference coverage from the NKF 2018 Spring Clinical Meetings in Austin hosted by the National Kidney Foundation. Renal & Urology News staff will be reporting on medical studies conducted by nephrologists and other specialists who are tops in their field in chronic kidney disease, dialysis, transplantation, and more. Check back for the latest news from NKF 2018.

AUSTIN, Texas—Targeting serum phosphate levels to 4.5 mg/dL or below in patients on hemodialysis (HD) may also reduce levels of fibroblast growth factor 23 (FGF23), researchers reported at the National Kidney Foundation's 2018 Spring Clinical Meetings.

In a randomized controlled trial (RCT), Ramya Bhargava, MBBS, of SUNY Upstate Medical University in Syracuse, New York, and Alastair Hutchison, MBChB, FRCP, MD, of Manchester University NHS Foundation Trust in the United Kingdom, assigned 104 hemodialysis (HD) patients at 2 centers to a lower (2.5 to 4.3 mg/dL) or higher (5.6 to 7.4 mg/dL) target range of serum phosphate. The groups had the same mean serum phosphate levels to start. During an 8-week titration period, participants reached their respective target phosphate ranges.

The investigators found a statistically significant 1.1 mg/dL difference in mean serum phosphate between groups during a 10-month maintenance phase. Serum phosphate was controlled to around 4.5 vs 6.0 mg/dL in the low- and high-target phosphate groups, respectively. Median serum FGF23 levels trended lower in the group with intensive phosphorus control, but by the end of the study, the reduction in FGF23 was no longer statistically significant.

 “Although the benefits of FGF23 reduction are unclear, this is the first RCT to demonstrate a distinct physiological consequence of different degrees of phosphate control,” Dr Bhargava and Dr Hutchison concluded. “Therefore the study provides a degree of validity to the target-driven approach to management of CKD-MBD [chronic kidney disease-mineral bone disease] and its cardiovascular consequences.”

See more coverage from the National Kidney Foundation Spring Clinical meeting

Reference

Bhargava R and Hutchison A. FGF23 concentrations in dialysis patients treated to a higher treatment target of serum phosphate. Poster presented at the National Kidney Foundation's 2018 Spring Clinical Meetings in Austin, Texas, April 10–14, 2018. Poster 165.

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