التفاصيل البيبلوغرافية
| العنوان: |
Kidney phosphate wasting predicts poor outcome in polycystic kidney disease. |
| المؤلفون: |
Xue, Laixi, Geurts, Frank, Meijer, Esther, Borst, Martin H de, Gansevoort, Ron T, Zietse, Robert, Hoorn, Ewout J, Salih, Mahdi, Consortium, the DIPAK |
| المصدر: |
Nephrology Dialysis Transplantation; Jul2024, Vol. 39 Issue 7, p1105-1114, 10p |
| مصطلحات موضوعية: |
POLYCYSTIC kidney disease, FIBROBLAST growth factors, RENAL replacement therapy |
| مصطلحات جغرافية: |
NETHERLANDS |
| مستخلص: |
Background Patients with autosomal dominant polycystic kidney disease (ADPKD) have disproportionately high levels of fibroblast growth factor 23 (FGF-23) for their chronic kidney disease stage, however only a subgroup develops kidney phosphate wasting. We assessed factors associated with phosphate wasting and hypothesize that it identifies patients with more severe disease and predicts disease progression. Methods We included 604 patients with ADPKD from a multicenter prospective observational cohort (DIPAK; Developing Intervention Strategies to Halt Progression of Autosomal Dominant Polycystic Kidney Disease) in four university medical centers in the Netherlands. We measured parathyroid hormone (PTH) and total plasma FGF-23 levels, and calculated the ratio of tubular maximum reabsorption rate of phosphate to glomerular filtration rate (TmP/GFR) with <0.8 mmol/L defined as kidney phosphate wasting. We analysed the association of TmP/GFR with estimated GFR (eGFR) decline over time and the risk for a composite kidney outcome (≥30% eGFR decline, kidney failure or kidney replacement therapy). Results In our cohort (age 48 ± 12 years, 39% male, eGFR 63 ± 28 mL/min/1.73 m2), 59% of patients had phosphate wasting. Male sex [coefficient –0.2, 95% confidence interval (CI) –0.2; –0.1], eGFR (0.002, 95% CI 0.001; 0.004), FGF-23 (0.1, 95% CI 0.03; 0.2), PTH (–0.2, 95% CI –0.3; –0.06) and copeptin (–0.08, 95% CI –0.1; –0.08) were associated with TmP/GFR. Corrected for PTH, FGF-23 and eGFR, every 0.1 mmol/L decrease in TmP/GFR was associated with a greater eGFR decline of 0.2 mL/min/1.73 m2/year (95% CI 0.01; 0.3) and an increased hazard ratio of 1.09 (95% CI 1.01; 1.18) of the composite kidney outcome. Conclusion Our study shows that in patients with ADPKD, phosphate wasting is prevalent and associated with more rapid disease progression. Phosphate wasting may be a consequence of early proximal tubular dysfunction and insufficient suppression of PTH. [ABSTRACT FROM AUTHOR] |
|
Copyright of Nephrology Dialysis Transplantation is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
Full Text Finder