FGF-23 in chronic kidney disease
FGF-23 (fibroblast growth factor-23) is a part of a family of phosphatonins that promotes renal phosphate excretion. It is a hormone secreted by osteocytes, and it regulates phosphorus and vitamin D metabolism. FGF23 promotes phosphaturia and decreases the production of calcitriol.
Its levels increase in early CKD as a physiological adaptation to maintain normal serum phosphate levels.
FGF-23 maintains normal serum phosphorus levels by three mechanisms:
(1) Phosphaturia- Increased renal phosphate excretion (by reducing tubular reabsorption of phosphorus)
(2) Secondary Hyperparathyroidism- stimulation of PTH, which also increases renal phosphate excretion
(3) Suppresses calcitriol formation-- suppression of the formation of 1,25(OH)2 D3, leading to diminished phosphorus absorption from the GI tract.
It becomes maladaptive by causing a progressive decline in 1,25(OH)(2)D levels. It leads to secondary hyperparathyroidism and related complications of bone metabolism.
FGF-23 is the independent risk factor for cardiovascular mortality
High levels of FGF-23 are also an independent risk factor for left ventricular hypertrophy and mortality in CKD, dialysis, and kidney transplant patients.
Elevated FGF-23 early in CKD means start phosphate restriction
The elevated levels of FGF-23 can be used as a marker for the need for therapeutic intervention (e.g., phosphate restriction), even when serum phosphate levels are within the normal range.
It is an emerging novel biomarker in the identification of CKD patients, which might benefit most from aggressive management of disordered phosphorus metabolism.
Increased FGF-23 is associated with high morbidity and mortality
There is a close association between FGF23 and incidences of infections, hospitalizations, myocardial infarction, heart failure, and death in CKD patients.
These incidences of higher morbidity and mortality suggest that FGF-23 is not only a biomarker of altered mineral metabolism and cardiovascular disease. But also, a therapeutic target.
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Revision for today Congenital Solitary Kidney - Creative Med Doses
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