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Abstract: PO0555

Calcium-Based Phosphate Binders and the Regulation of FGF-23

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Rodelo-Haad, Cristian, Hospital Universitario Reina Sofia, Cordoba, Andalucía, Spain
  • Ciudad-Montejo, Marta, Hospital Universitario Reina Sofia, Cordoba, Andalucía, Spain
  • Rodríguez Fuentes, David Antonio, Hospital Universitario Reina Sofia, Cordoba, Andalucía, Spain
  • López-López, Isabel, Hospital Universitario Reina Sofia, Cordoba, Andalucía, Spain
  • Pendon-Ruiz de Mier, Victoria, Hospital Universitario Reina Sofia, Cordoba, Andalucía, Spain
  • Munoz-Castaneda, Juan R., Instituto Maimonides de Investigacion Biomedica de Cordoba, Cordoba, Andalucía, Spain
  • Rodriguez, Mariano, Hospital Universitario Reina Sofia, Cordoba, Andalucía, Spain
  • Martin-Malo, Alejandro, Hospital Universitario Reina Sofia, Cordoba, Andalucía, Spain
Background

Phosphate and calcium load are associated with FGF23 increase. Reduction of intestinal phosphate absorption by Calcium-based binders (Ca-bB) should decrease serum FGF23, but the opposed effect may result from calcium load derived from Ca-bB-administration. Since Ca-bB has been associated with vascular calcifications and FGF23 is an independent risk factor for cardiovascular disease (CVD), it is relevant to elucidate the effect of Ca-bB on FGF23. Thus, we aimed to determine the effect of Ca-bB on serum levels of FGF23 in hemodialysis (HD) patients.

Methods

We included 121 prevalent HD patients. Serum phosphate,Ca, iPTH and intactFGF23 were measured. 52 patients were on Calcium-free (NoCa-bB) binders, whereas 69 were on calcium-based (Ca-bB, n=69) binders. We also considered treatments with cinacalcet, paricalcitol and the calcium dialysate content. Multivariable regression identified the variables associated with FGF23 increase. Statistics were performed using R

Results

The mean age was 67.8±14.7. Serum levels of phosphate, Ca and iPTH were comparable between groups of binders (Fig 1A,B,andC). iFGF23 was higher in patients on Ca-bB than in NoCa-bB (2815.7vs1268.09 pg/ml, p<0.001). Multivariable regression, adjusted for iPTH, dialysate calcium, albumin, and the treatment with cinacalcet and paricalcitol, showed that the use of Ca-bB was associated with increased serum iFGF23 (beta=0.46, p=0.01).

Conclusion

At equivalent serum levels of serum phosphate, Ca, and iPTH, the use of Ca-bB is independently associated with higher serum iFGF23. This could partially explain the detrimental cardiovascular effects associated with Ca-bB use in HD patients.

iFGF23 serum levels according to the different phosphate binders received

Funding

  • Government Support – Non-U.S.