Response of fibroblast growth factor 23 to volume interventions in arterial hypertension and diabetic nephropathy.

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From: Medicine(Vol. 95, Issue 44)
Publisher: Lippincott Williams & Wilkins, WK Health
Document Type: Report; Author abstract
Length: 318 words

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Byline: Jelmer K. Humalda, Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg, Germany Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands.; Sarah Seiler-Muler; Arjan J. Kwakernaak; Marc G. Vervloet; Gerjan Navis; Danilo Fliser; Gunnar H. Heine; Martin H. de Borst Abstract Fibroblast growth factor 23 (FGF-23) rises progressively in chronic kidney disease and is associated with adverse cardiovascular outcomes. FGF-23 putatively induces volume retention by upregulating the sodium-chloride cotransporter (NCC). We studied whether, conversely, interventions in volume status affect FGF-23 concentrations.We performed a post hoc analysis of 1) a prospective saline infusion study with 12 patients with arterial hypertension who received 2ÇèL of isotonic saline over 4 hours, and 2) a randomized controlled trial with 45 diabetic nephropathy (DN) patients on background angiotensin-converting enzyme -inhibition (ACEi), who underwent 4 6-week treatment periods with add-on hydrochlorothiazide (HCT) or placebo, combined with regular sodium (RS) or low sodium (LS) diet in a cross-over design. Plasma C-terminal FGF-23 was measured by ELISA (Immutopics) after each treatment period in DN and before and after saline infusion in hypertensives.The patients with arterial hypertension were 45ÇèØÇè13 (meanÇèØÇèSD) years old with an estimated glomerular filtration rate (eGFR) of 101ÇèØÇè18ÇèmL/min/1.73Çèm2. Isotonic saline infusion did not affect FGF-23 (before infusion: 68 median [first to third quartile: 58-97] relative unit (RU)/mL, after infusion: 67 [57-77]ÇèRU/mL, PÇè=Çè0.37). DN patients were 65ÇèØÇè9 years old. During ACEiÇè+ÇèRS treatment, eGFR was 65ÇèØÇè25ÇèmL/min/1.73Çèm2 and albuminuria 649Çèmg/d (230-2008Çèmg/d). FGF23 level was 94 (73-141)ÇèRU/mL during ACEi therapy. FGF-23 did not change significantly by add-on HCT (99 [74-148]ÇèRU/mL), LS diet (99 [75-135]ÇèRU/mL), or their combination (111 [81-160]ÇèRU/mL, PÇè=Çè0.15).Acute and chronic changes in volume status did not materially change FGF-23 in hypertensive patients and DN, respectively. Our data do not support a direct feedback loop between volume status and FGF-23 in hypertension or DN.

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Gale Document Number: GALE|A671664480