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Total parathyroidectomy reduces elevated circulating fibroblast growth factor 23 in advanced secondary hyperparathyroidism.

AbstractBACKGROUND:
Secondary hyperparathyroidism is a common complication in patients with stage 5 chronic kidney disease (CKD), accelerated by hyperphosphatemia. Fibroblast growth factor 23 (FGF-23), a phosphorus-regulating protein, has key roles in several phosphate-wasting disorders. The aim of this study is to examine the association of advanced secondary hyperparathyroidism with circulating FGF-23 levels.
METHODS:
Fifteen patients with marked secondary hyperparathyroidism (parathyroid hormone [PTH], 990 +/- 118 pg/mL [ng/L]) were enrolled. All underwent parathyroidectomy with forearm autotransplantation (PTX), and their FGF-23 levels were measured before and after PTX (days 1, 3, 7, and 10) by means of sandwich enzyme-linked immunosorbent assay.
RESULTS:
Preoperative FGF-23 levels correlated positively with phosphorus (P < 0.05), calcium-phosphorus product (Ca x P; P < 0.0005), and PTH values (P < 0.05). Serum FGF-23 levels decreased time dependently after PTX (P < 0.0005). Both serum phosphorus and Ca x P values decreased similarly after PTX ( P = 0.0001). Furthermore, FGF-23 levels days 1 and 3 correlated linearly with serum phosphorus (P < 0.05; P < 0.005, respectively) and Ca x P values (P < 0.01; P < 0.0001, respectively).
CONCLUSION:
FGF-23 levels correlate positively with serum phosphorus, Ca x P, and PTH values in patients with advanced secondary hyperparathyroidism. Complete ablation of progressive parathyroid glands reduces circulating FGF-23 levels, simultaneously decreasing serum phosphorus and Ca x P values. These findings suggest that hyperplastic parathyroid glands, together with hyperphosphatemia, affect abnormal FGF-23 metabolism in patients with stage 5 CKD with advanced secondary hyperparathyroidism.
AuthorsTetsuhiko Sato, Yoshihiro Tominaga, Tsuneo Ueki, Norihiko Goto, Susumu Matsuoka, Akio Katayama, Toshihito Haba, Kazuharu Uchida, Shohei Nakanishi, Junichiro James Kazama, Fumitake Gejyo, Takeyoshi Yamashita, Masafumi Fukagawa
JournalAmerican journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 44 Issue 3 Pg. 481-7 (Sep 2004) ISSN: 1523-6838 [Electronic] United States
PMID15332221 (Publication Type: Journal Article)
Chemical References
  • FGF23 protein, human
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23
Topics
  • Chronic Disease
  • Female
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors (blood)
  • Humans
  • Hyperparathyroidism, Secondary (blood, etiology, surgery)
  • Kidney Diseases (complications, therapy)
  • Male
  • Middle Aged
  • Parathyroidectomy
  • Renal Dialysis

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