| Pilot study of dietary phosphorus restriction and phosphorus binders to target fibroblast growth factor 23 in patients with chronic kidney disease. | |
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MedLine Citation:
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PMID: 20631407 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: High levels of fibroblast growth factor 23 (FGF23) are associated with mortality and progression of chronic kidney disease (CKD). Reducing dietary phosphorus intake lowers FGF23 secretion in healthly individuals, but there is little data on its effects in patients with pre-dialysis CKD. METHODS: Using a 2×2 factorial design, we randomly assigned 16 normophosphataemic CKD stage 3-4 patients to receive a 2-week treatment with either lanthanum carbonate 1000 mg three times daily or placebo, and to ingest a tightly controlled diet containing 750 or 1500 mg of dietary phosphorus daily. We analysed serial measurements of FGF23, parathyroid hormone, serum phosphate and calcium, and 24-h urinary phosphate and calcium excretion using repeated-measures analyses. RESULTS: Compared with the 1500-mg phosphorus diet, patients assigned to the 750-mg diet had greater reduction in 24-h urinary phosphate excretion (66% vs. 29%; P<0.0001). Lanthanum-treated patients experienced a significant reduction in 24-h urinary phosphate excretion compared with baseline (64%; P<0.0001), but the difference compared with placebo did not reach significance (64% vs. 31%). Despite the significant reductions in 24-h urinary phosphate excretion, no group demonstrated a significant reduction in FGF23 levels; FGF23 levels actually increased significantly in the 1500-mg diet plus placebo group, suggesting dietary phosphorus loading. CONCLUSIONS: Although dietary phosphorus restriction and lanthanum lowered urinary phosphate excretion consistent with a rapid decrease in phosphorus absorption, inducing a reduction in FGF23 levels in CKD patients may require interventions with a longer duration than in healthy volunteers. |
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Authors:
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Tamara Isakova; Orlando M Gutiérrez; Kelsey Smith; Michael Epstein; Leigh K Keating; Harald Jüppner; Myles Wolf |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2010-07-14 |
Journal Detail:
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Title: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Volume: 26 ISSN: 1460-2385 ISO Abbreviation: Nephrol. Dial. Transplant. Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-01-28 Completed Date: 2011-07-14 Revised Date: 2012-02-01 |
Medline Journal Info:
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Nlm Unique ID: 8706402 Medline TA: Nephrol Dial Transplant Country: England |
Other Details:
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Languages: eng Pagination: 584-91 Citation Subset: IM |
Affiliation:
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Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA. tisakova@med.miami.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Chelating Agents / therapeutic use* Fibroblast Growth Factors / metabolism* Humans Kidney Failure, Chronic / diet therapy*, drug therapy* Lanthanum / therapeutic use* Middle Aged Phosphorus Compounds / metabolism* Phosphorus, Dietary Pilot Projects |
| Grant Support | |
ID/Acronym/Agency:
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K23DK081673/DK/NIDDK NIH HHS; M01RR01066/RR/NCRR NIH HHS; R01DK076116/DK/NIDDK NIH HHS; R01DK081374/DK/NIDDK NIH HHS; UL1RR025758-01/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Chelating Agents; 0/Phosphorus Compounds; 0/Phosphorus, Dietary; 0/fibroblast growth factor 23; 0/lanthanum carbonate; 62031-54-3/Fibroblast Growth Factors; 7439-91-0/Lanthanum |
| Comments/Corrections | |
Comment In:
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Nephrol Dial Transplant. 2011 May;26(5):1749-50; author reply 1750
[PMID:
21372258
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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