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Factors associated with 1-year changes in serum fibroblast growth factor 23 levels in pediatric patients with chronic kidney disease

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Abstract

Background

Fibroblast growth factor 23 (FGF23) levels increase as kidney function decreases and are associated with increased mortality in patients with chronic kidney disease (CKD). Inflammation has also been shown to increase FGF23 production in adults; however, this has not been validated in pediatric patients with CKD. Furthermore, previous studies on children involved a single measurement of FGF23 without a follow-up, and a few studies have examined changes in FGF23 levels.

Methods

We measured the levels of serum intact FGF23, tumor necrosis factor-α (TNF-α), and interleukin-6 as parameters of inflammation and other variables related to bone metabolism at baseline and after 1 year in 62 pediatric patients with CKD (stages 2–5D, 1–16 years old). Factors related to changes in FGF23 levels were investigated.

Results

The median age of patients at the evaluation was 10.5 years (interquartile range 6.0–14.0), and the estimated glomerular filtration rate (eGFR) was 59.0 mL/min/1.73 m2 (45.1–69.3). Primary diseases included congenital anomalies of the kidney and urinary tract, ischemic kidney, and glomerulonephritis. The baseline value of FGF23 was 66.5 pg/mL (48.3–96.4), and percent change in FGF23 levels after 1 year was 8.5% (− 29.9–74.7). The percent change in FGF23 levels showed a negative correlation with that in eGFR (P = 0.010), and a positive correlation with that in TNF-α levels (P = 0.035). A multivariate linear regression analysis identified TNF-α as an independent factor increasing FGF23 levels.

Conclusions

An increase in TNF-α levels is associated with elevation of FGF23 levels in pediatric patients with CKD.

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Acknowledgements

The present study was supported by the Sukoyaka Grant for Maternal and Child Health. We would like to express our deepest appreciation to Dr. Misaki Moriishi, the head of the TSUBASA project led by the Japanese Society for Dialysis Therapy, who provided valuable advice on the present study.

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Authors and Affiliations

  1. Department of Pediatric Nephrology and Metabolism, Osaka Women’s and Children’s Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan

    Natsumi Yamamura-Miyazaki, Toshimi Michigami & Katsusuke Yamamoto

  2. Department of Bone and Mineral Research, Research Institute, Osaka Women’s and Children’s Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan

    Toshimi Michigami

  3. Department of Pediatrics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan

    Keiichi Ozono

  4. Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Yukiko Hasuike

Authors
  1. Natsumi Yamamura-Miyazaki
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  2. Toshimi Michigami
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  3. Keiichi Ozono
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  4. Katsusuke Yamamoto
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Contributions

NYM, YH, and TM designed the study. NYM analyzed data and drafted the manuscript. All authors commented on previous versions and approved the final version of the manuscript.

Corresponding author

Correspondence to Natsumi Yamamura-Miyazaki.

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Conflict of interest

All authors declare no conflicts of interest concerning the present study. Toshimi Michigami and Keiichi Ozono have received honorarium for lecture from Kyowa Kirin Co., Ltd. The other authors have no potential conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Boards of Osaka Women’s and Children’s Hospital (No. 1012) and the Hyogo College of Medicine (No. 2815), and was registered at the University Hospital Medical Information Network in Japan with the identifier UMIN000033064 on August 29, 2017.

Informed consent

Written informed consent was obtained from all parents included in the study, along with assent from children where appropriate.

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Yamamura-Miyazaki, N., Michigami, T., Ozono, K. et al. Factors associated with 1-year changes in serum fibroblast growth factor 23 levels in pediatric patients with chronic kidney disease. Clin Exp Nephrol 26, 1014–1021 (2022). https://doi.org/10.1007/s10157-022-02238-5

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  • DOI: https://doi.org/10.1007/s10157-022-02238-5

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