Fibroblast growth factor 23 in chronic kidney disease: New insights and clinical implications

Authors


Dr Matthew John Damasiewicz, Department of Nephrology, Monash Medical Centre and Department of Medicine, Monash University, Clayton 3168, Victoria, Australia. Email: Matthew.Damasiewicz@monash.edu

ABSTRACT

Fibroblast growth factor 23 (FGF-23) is a recently discovered regulator of phosphate and mineral metabolism. Its main physiological function is the enhancement of renal phosphate excretion. FGF-23 levels are inversely related to renal function and in patients with chronic kidney disease (CKD) elevation in FGF-23 precedes the rise of serum phosphate. Studies have demonstrated an important role for FGF-23 in the development of secondary hyperparathyroidism through an effect on parathyroid hormone and calcitriol. In cross-sectional studies FGF-23 has been associated with surrogate markers of cardiovascular disease such as endothelial dysfunction and arterial stiffness. FGF-23 has also been associated with both progression of CKD and mortality in dialysis patients. The discovery of FGF-23 has provided a profound new insight into bone and mineral metabolism, and it may become an important biomarker and therapeutic target in CKD.

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