Clinical journal of the American Society of Nephrology : CJASN · 2009
Early control of PTH and FGF23 in normophosphatemic CKD patients: a new target in CKD-MBD therapy?
Сравнительное исследованиеСтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Oliveira Rodrigo B, Cancela Ana L E, Graciolli Fabiana G, Dos Reis Luciene M, Draibe Sérgio A, Cuppari Lilian, Carvalho Aluizio B, Jorgetti Vanda, Canziani Maria E, Moysés Rosa M A
Аннотация
BACKGROUND AND OBJECTIVES: Levels of parathyroid hormone (PTH) and the phosphaturic hormone FGF23, a fibroblast growth factor (FGF) family member, increase early in chronic kidney disease (CKD) before the occurrence of hyperphosphatemia. This short-term 6-wk dose titration study evaluated the effect of two phosphate binders on PTH and FGF23 levels in patients with CKD stages 3 to 4.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Patients were randomized to receive over a 6-wk period either calcium acetate (n = 19) or sevelamer hydrochloride (n = 21).
RESULTS: At baseline, patients presented with elevated fractional excretion of phosphate, serum PTH, and FGF23. During treatment with both phosphate binders there was a progressive decline in serum PTH and urinary phosphate, but no change in serum calcium or serum phosphate. Significant changes were observed for FGF23 only in sevelamer-treated patients.
CONCLUSIONS: This study confirms the positive effects of early prescription of phosphate binders on PTH control. Prospective and long-term studies are necessary to confirm the effects of sevelamer on serum FGF23 and the benefits of this decrease on outcomes.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Patients were randomized to receive over a 6-wk period either calcium acetate (n = 19) or sevelamer hydrochloride (n = 21).
RESULTS: At baseline, patients presented with elevated fractional excretion of phosphate, serum PTH, and FGF23. During treatment with both phosphate binders there was a progressive decline in serum PTH and urinary phosphate, but no change in serum calcium or serum phosphate. Significant changes were observed for FGF23 only in sevelamer-treated patients.
CONCLUSIONS: This study confirms the positive effects of early prescription of phosphate binders on PTH control. Prospective and long-term studies are necessary to confirm the effects of sevelamer on serum FGF23 and the benefits of this decrease on outcomes.
Предметные рубрики MeSH
AcetatesAdultBiomarkersBone Diseases, MetabolicCalcium CompoundsChelating AgentsChronic DiseaseFemaleFibroblast Growth Factor-23Fibroblast Growth FactorsHumansHyperparathyroidism, SecondaryKidney DiseasesMaleMiddle AgedParathyroid HormonePhosphatesPilot ProjectsPolyaminesSevelamerTime FactorsTreatment Outcome