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Title: Early Control of PTH and FGF23 in Normophosphatemic CKD Patients: A New Target in CKD-MBD Therapy?
Authors: Oliveira, Rodrigo Bueno de
Cancela, Ana Ludmila Espada
Graciolli, Fabiana G.
Reis, Luciene M. dos
Draibe, Sergio Antonio [UNIFESP]
Cuppari, Lilian [UNIFESP]
Carvalho, Aluizio Barbosa de [UNIFESP]
Jorgetti, Vanda
Canziani, Maria Eugenia [UNIFESP]
Moyses, Rosa Maria Affonso
Universidade de São Paulo (USP)
Universidade Federal de São Paulo (UNIFESP)
Issue Date: 1-Feb-2010
Publisher: Amer Soc Nephrology
Citation: Clinical Journal of the American Society of Nephrology. Washington: Amer Soc Nephrology, v. 5, n. 2, p. 286-291, 2010.
Abstract: 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. Clin J Am Soc Nephrol 5: 286-291, 2010. doi: 10.2215/CJN.05420709
ISSN: 1555-9041
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