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Assessment of tubular reabsorption of phosphate as a surrogate marker for phosphate regulation in chronic kidney disease

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Abstract

Background/Aims

Fibroblast growth factor 23 (FGF23) and soluble α-Klotho are emerging potential biomarkers of phosphorus and vitamin D metabolism which change in concentration in early chronic kidney disease (CKD) in order to maintain normal phosphorus levels. Tubular reabsorption of phosphate (TRP) has been commonly used to assess renal tubular phosphate transport. The aim of this study was to evaluate the usefulness of TRP as a surrogate marker of parameters of CKD-mineral bone disease (CKD-MBD) in CKD.

Methods

A cross-sectional study was performed in 93 stable patients with predialysis CKD stage 1–5. In all patients, TRP, estimated glomerular filtration rate (eGFR), calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D, serum FGF23 and urine soluble α-Klotho levels were measured.

Results

As renal function declined, TRP significantly decreased (P < 0.001; r = 0.763) and both iPTH and serum FGF23 increased (P < 0.001; r = −0.598, P < 0.001; r = −0.453, respectively). The prevalence of hyperphosphatemia, secondary hyperparathyroidism, FGF23 excess and abnormal TRP increased progressively with declining eGFR. Although TRP level changed later than FGF23, abnormal levels of both TRP and FGF23 were observed earlier than changes in iPTH and serum phosphate. Decreased TRP was found to be independently associated with decreased eGFR and increased iPTH but was not associated with urine soluble α-Klotho or serum FGF23 level in multiple linear regression analysis.

Conclusion

TRP is a simple, useful and cost-saving surrogate marker of the assessment of altered mineral metabolism in CKD patients and can be used as an alternative to serum FGF23, especially for mild to moderate renal insufficiency.

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Acknowledgments

The authors would like to thank Professor S. W. Kim of the Division of Urology, The Catholic University of Korea and Professor B. S. Choi of Seogang University for their valuable discussions. This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (C·W.P; A111055).

Conflict of interest

The authors have declared that no conflicts of interest exist.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 152-703, Korea

    Yu Ah Hong

  2. Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea

    Ji Hee Lim, Min Young Kim, Yaeni Kim, Keun Suk Yang, Byung Ha Chung, Sung** Chung, Bum Soon Choi, Chul Woo Yang, Yong-Soo Kim, Yoon Sik Chang & Cheol Whee Park

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Hong, Y.A., Lim, J.H., Kim, M.Y. et al. Assessment of tubular reabsorption of phosphate as a surrogate marker for phosphate regulation in chronic kidney disease. Clin Exp Nephrol 19, 208–215 (2015). https://doi.org/10.1007/s10157-014-0962-5

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  • DOI: https://doi.org/10.1007/s10157-014-0962-5

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