TY - JOUR
T1 - The urinary phosphate to serum fibroblast growth factor 23 ratio is a useful marker of atherosclerosis in early-stage chronic kidney disease
AU - Yamada, Hodaka
AU - Kuro-o, Makoto
AU - Hara, Kazuo
AU - Ueda, Yuichiro
AU - Kusaka, Ikuyo
AU - Kakei, Masafumi
AU - Ishikawa, San E.
N1 - Funding Information:
M. K. is supported by research grants from AMED-CREST, JST, MEXT-Supported Program for the Strategic Research Foundation at Private Universities, and Vehicle Racing Commemorative Foundation. This research was supported by grant from The Kidney Foundation, Japan (JKFB15-33). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors thank Taeko Otani for the assistance with the ELISA technique.
PY - 2016/8
Y1 - 2016/8
N2 - Background: Fibroblast growth factor 23 (FGF23) regulates mineral homeostasis. In developed renal dysfunction, FGF23 levels increase to maintain the phosphate excretion capacity. However, in diabetic patients with early-stage renal impairment, the FGF23 elevation is not very sensitive. We hypothesized that urinary phosphate (U-P)/serum FGF23 ratio would theoretically be an index that reflects the number of nephrons (nephron index). In this study, we determined whether the nephron index would be associated with renal function and vascular diseases in diabetic patients. Methods: In total, 142 patients with diabetes mellitus were enrolled. The nephron index was calculated using the following formula: U-P (mg/day)/ serum FGF23 (pg/ml). Results: The mean age was 63 ± 11 years and eGFR levels were 79.5 ± 25.4 ml/min/1.73 m2, respectively. Thirty patients had a medical history of macroangiopathy. The Nephron index was significantly decreased in subjects with macroangiopathy compared with those without macroangiopathy. A multivariate analysis of risk factors for macroangiopathy revealed that duration of diabetes, eGFR, and nephron index were significantly associated with a higher frequency of arteriosclerotic disease. Conclusion: These findings suggest that a decrease in nephron index reflects early-stage renal impairment and is an independent risk factor of macroangiopathy in diabetic patients.
AB - Background: Fibroblast growth factor 23 (FGF23) regulates mineral homeostasis. In developed renal dysfunction, FGF23 levels increase to maintain the phosphate excretion capacity. However, in diabetic patients with early-stage renal impairment, the FGF23 elevation is not very sensitive. We hypothesized that urinary phosphate (U-P)/serum FGF23 ratio would theoretically be an index that reflects the number of nephrons (nephron index). In this study, we determined whether the nephron index would be associated with renal function and vascular diseases in diabetic patients. Methods: In total, 142 patients with diabetes mellitus were enrolled. The nephron index was calculated using the following formula: U-P (mg/day)/ serum FGF23 (pg/ml). Results: The mean age was 63 ± 11 years and eGFR levels were 79.5 ± 25.4 ml/min/1.73 m2, respectively. Thirty patients had a medical history of macroangiopathy. The Nephron index was significantly decreased in subjects with macroangiopathy compared with those without macroangiopathy. A multivariate analysis of risk factors for macroangiopathy revealed that duration of diabetes, eGFR, and nephron index were significantly associated with a higher frequency of arteriosclerotic disease. Conclusion: These findings suggest that a decrease in nephron index reflects early-stage renal impairment and is an independent risk factor of macroangiopathy in diabetic patients.
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U2 - 10.1371/journal.pone.0160782
DO - 10.1371/journal.pone.0160782
M3 - Article
C2 - 27504998
AN - SCOPUS:84983616684
VL - 11
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 8
M1 - e0160782
ER -