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FGF23 is associated with early post-transplant hypophosphataemia and normalizes faster than iPTH in living donor renal transplant recipients: a longitudinal follow-up study

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ABSTRACT

Background: We aimed to longitudinally analyse changes in the levels of serum fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH) and associated minerals in patients undergoing renal transplantation.

Methods: Sixty-three patients with end-stage renal disease (ESRD) who underwent living donor transplantation were recruited. Serum FGF23, iPTH, uric acid, inorganic phosphorous (iP), blood urea nitrogen and serum creatinine were measured pre-transplant and at 1 (M1), 3 (M3) and 12 months (M12) post-transplantation.

Results: FGF23 levels were decreased at M1, M3 and M12 by 93.81, 96.74 and 97.53%, respectively. iPTH levels were decreased by 67.95, 74.95 and 84.9%, respectively. The prevalence of hyperparathyroidism at M1, M3 and M12 post-transplantation was 63.5, 42.9 and 11.1%, respectively. FGF23 and iP levels remained above the normal range in 23 (36.5%) and 17 (27%) patients at M1, 10 (15.9%) and 5 (8%) at M3 and in none at M12 post-transplantation, respectively. A multivariate regression model revealed that, pre-transplant, iP was positively associated with iPTH (P = 0.016) but not with FGF 23; however, post-transplant, iP level was negatively associated with FGF23 (P < 0.001) but not with iPTH.

Conclusions: Post-transplant FGF23 levels settle faster than those of iPTH. However, 11% of patients continued to have hyperparathyroidism even after 12 months.

No MeSH data available.


Changes in FGF23 and iPTH levels at different post-transplant periods.
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SFW065F1: Changes in FGF23 and iPTH levels at different post-transplant periods.

Mentions: Compared with pre-transplant, intact FGF23 levels decreased by 93.81, 96.74 and 97.53%, while iPTH levels decreased by 67.95, 74.95 and 84.9% at M1, M3 and M12 post-transplantation, respectively. FGF23 levels remained above the normal range (<50 pg/mL) in 23 (36.5%) patients at M1, in 10 (15.9%) at M3 and in none at M12 post-transplantation. Hyperparathyroidism with a cut-off value of >65 pg/mL [22] was observed in 40 (63.5%), 27 (42.9%) and 7 (11.1%) patients at M1, M3 and M12 post-transplantation, respectively (Figure 1). Forty patients who continued to have hyperparathyroidism at M1 also had higher iPTH levels pre-transplantation (397.41 ± 269.15 versus 268.76 ± 128.24 pg/mL; P = 0.013) compared with those who achieved normal iPTH levels at M1. The higher values of iPTH persisted until M3 post-transplantation (109.32 ± 74.15 versus 50.29 ± 13.64 pg/mL; P < 0.001). Patients with persisting hyperparathyroidism at M1 also had higher FGF23 (99.97 ± 86.95 versus 51.85 ± 30.71 pg/mL; P = 0.003) at M1; however, FGF23 levels gradually became normal in all patients. The percentage reductions in FGF23 and iPTH were significantly associated with each other at M1 (r = 0.35, P = 0.004), M3 (r = 0.28, P = 0.026) and M12 (r = 0.35, P = 0.004). In addition, patients with persisting hyperparathyroidism at M1 had significantly lower eGFRs and greater BUN at M1 and M3.Fig. 1.


FGF23 is associated with early post-transplant hypophosphataemia and normalizes faster than iPTH in living donor renal transplant recipients: a longitudinal follow-up study
Changes in FGF23 and iPTH levels at different post-transplant periods.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036900&req=5

SFW065F1: Changes in FGF23 and iPTH levels at different post-transplant periods.
Mentions: Compared with pre-transplant, intact FGF23 levels decreased by 93.81, 96.74 and 97.53%, while iPTH levels decreased by 67.95, 74.95 and 84.9% at M1, M3 and M12 post-transplantation, respectively. FGF23 levels remained above the normal range (<50 pg/mL) in 23 (36.5%) patients at M1, in 10 (15.9%) at M3 and in none at M12 post-transplantation. Hyperparathyroidism with a cut-off value of >65 pg/mL [22] was observed in 40 (63.5%), 27 (42.9%) and 7 (11.1%) patients at M1, M3 and M12 post-transplantation, respectively (Figure 1). Forty patients who continued to have hyperparathyroidism at M1 also had higher iPTH levels pre-transplantation (397.41 ± 269.15 versus 268.76 ± 128.24 pg/mL; P = 0.013) compared with those who achieved normal iPTH levels at M1. The higher values of iPTH persisted until M3 post-transplantation (109.32 ± 74.15 versus 50.29 ± 13.64 pg/mL; P < 0.001). Patients with persisting hyperparathyroidism at M1 also had higher FGF23 (99.97 ± 86.95 versus 51.85 ± 30.71 pg/mL; P = 0.003) at M1; however, FGF23 levels gradually became normal in all patients. The percentage reductions in FGF23 and iPTH were significantly associated with each other at M1 (r = 0.35, P = 0.004), M3 (r = 0.28, P = 0.026) and M12 (r = 0.35, P = 0.004). In addition, patients with persisting hyperparathyroidism at M1 had significantly lower eGFRs and greater BUN at M1 and M3.Fig. 1.

View Article: PubMed Central - PubMed

ABSTRACT

Background: We aimed to longitudinally analyse changes in the levels of serum fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH) and associated minerals in patients undergoing renal transplantation.

Methods: Sixty-three patients with end-stage renal disease (ESRD) who underwent living donor transplantation were recruited. Serum FGF23, iPTH, uric acid, inorganic phosphorous (iP), blood urea nitrogen and serum creatinine were measured pre-transplant and at 1 (M1), 3 (M3) and 12 months (M12) post-transplantation.

Results: FGF23 levels were decreased at M1, M3 and M12 by 93.81, 96.74 and 97.53%, respectively. iPTH levels were decreased by 67.95, 74.95 and 84.9%, respectively. The prevalence of hyperparathyroidism at M1, M3 and M12 post-transplantation was 63.5, 42.9 and 11.1%, respectively. FGF23 and iP levels remained above the normal range in 23 (36.5%) and 17 (27%) patients at M1, 10 (15.9%) and 5 (8%) at M3 and in none at M12 post-transplantation, respectively. A multivariate regression model revealed that, pre-transplant, iP was positively associated with iPTH (P = 0.016) but not with FGF 23; however, post-transplant, iP level was negatively associated with FGF23 (P &lt; 0.001) but not with iPTH.

Conclusions: Post-transplant FGF23 levels settle faster than those of iPTH. However, 11% of patients continued to have hyperparathyroidism even after 12 months.

No MeSH data available.