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      Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease.

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          Abstract

          Fibroblast growth factor 23 (FGF23) regulates phosphorus metabolism and is a strong predictor of mortality in dialysis patients. FGF23 is thought to be an early biomarker of disordered phosphorus metabolism in the initial stages of chronic kidney disease (CKD). We measured FGF23 in baseline samples from 3879 patients in the Chronic Renal Insufficiency Cohort study, which is a diverse cohort of patients with CKD stage 2-4. Mean serum phosphate and median parathyroid hormone (PTH) levels were in the normal range, but median FGF23 was markedly greater than in healthy populations, and increased significantly with decreasing estimated glomerular filtration rate (eGFR). High levels of FGF23, defined as being above 100 RU/ml, were more common than secondary hyperparathyroidism and hyperphosphatemia in all strata of eGFR. The threshold of eGFR at which the slope of FGF23 increased was significantly higher than the corresponding threshold for PTH based on non-overlapping 95% confidence intervals. Thus, increased FGF23 is a common manifestation of CKD that develops earlier than increased phosphate or PTH. Hence, FGF23 measurements may be a sensitive early biomarker of disordered phosphorus metabolism in patients with CKD and normal serum phosphate levels.

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          Author and article information

          Journal
          Kidney Int
          Kidney international
          Springer Science and Business Media LLC
          1523-1755
          0085-2538
          Jun 2011
          : 79
          : 12
          Affiliations
          [1 ] Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
          Article
          S0085-2538(15)54749-2 NIHMS305454
          10.1038/ki.2011.47
          3134393
          21389978
          fdfbf8d1-24db-4221-8ad1-da57f94e824f
          History

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