Poor kidney response to hormone may increase risks for kidney disease patients

March 21, 2013

The kidneys' response to a particular hormone may affect kidney disease patients' heart health and longevity, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings may help doctors as they monitor and treat patients with kidney disease.

In patients with (CKD), blood levels of a hormone called fibroblast growth factor-23 (FGF-23) rise in parallel with declining , causing excess excretion of phosphorus in the urine. Also, FGF-23 has been consistently and strongly linked with heart disease and premature death, but the mechanisms behind these links are unclear.

Julie Dominguez, MD, Joachim Ix, MD (University of California San Diego, and Veterans Affairs San Diego Healthcare System) and their colleagues wondered whether the kidneys' response to the hormonal actions of FGF-23 may play a role. To investigate, they measured blood levels of FGF-23 and urine levels of phosphorus in 872 patients with CKD and cardiovascular disease.

Among the major findings:

  • During an average 7.5 years of follow-up, there were 337 deaths and 199 cardiovascular events, such as heart attacks and strokes.
  • Urinary phosphorus excretion significantly modified FGF-23's links with premature death and heart disease. Patients who had above-average FGF-23 but below-average urinary phosphorus had the highest risks of both premature death and cardiovascular events.
The findings reveal that associations of FGF-23 with and are stronger in people with lower urinary phosphorus independent of kidney function. In these individuals, the kidney's response to FGF-23 may be suboptimal.

"The relative resistance to the hormonal actions of FGF-23 in the kidney may identify novel aspects of , which may hold prognostic information for adverse health," said Dr. Ix. "Future studies are needed to determine the mechanisms of relative kidney resistance, and to determine their prognostic implications for other outcomes such as progression of kidney disease."

In an accompanying editorial, Ishir Bhan, MD, and Ravi Thadhani, MD (Massachusetts General Hospital) noted that the study prompts new questions to guide future studies into FGF-23 biology. "Perhaps the most important role of this study is to begin to shed some light on potential underlying mechanisms that might be at play in the complex relationship of FGF-23 and clinical effects, but many more questions are raised that this study is unable to answer," they wrote.

Explore further: Poorer outcomes linked with certain hormone for patients with early-stage chronic kidney disease

More information: The article, entitled "Fractional Excretion of Phosphorus Modifies the Association Between FGF23 and Outcomes," will appear online on March 21, 2013, doi: 10.1681/2012090894.

The editorial, entitled "Fibroblast Growth Factor-23 and Outcomes: New Answers, New Questions," will appear online on March 21, 2013, doi: 10.1681/ASN.2013020169

Related Stories

Poorer outcomes linked with certain hormone for patients with early-stage chronic kidney disease

June 14, 2011
Patients in the early stages of chronic kidney disease who had elevated levels of the endocrine hormone fibroblast growth factor 23 (that regulates phosphorus metabolism) had an associated increased risk of end-stage renal ...

Researchers find hormone that predicts premature death in kidney patients

September 9, 2011
Researchers at the University of Colorado School of Medicine have found that high levels of a specific hormone can predict which kidney patients will develop heart problems, require dialysis or die prematurely.

Study questions safety and effectiveness of common kidney disease drugs

July 19, 2012
Drugs commonly prescribed to patients with chronic kidney disease (CKD) may not be as strongly effective as once thought, and may cause unexpected harm to blood vessels, according to a study appearing in an upcoming issue ...

Problems with mineral metabolism linked with kidney disease progression

December 13, 2012
Abnormalities of mineral metabolism worsen with progressive chronic kidney disease (CKD) and are linked with a higher risk for kidney failure among African Americans, according to a study appearing in an upcoming issue of ...

Recommended for you

Newly discovered viral marker could help predict flu severity in infected patients

October 20, 2017
Flu viruses contain defective genetic material that may activate the immune system in infected patients, and new research published in PLOS Pathogens suggests that lower levels of these molecules could increase flu severity.

Flu simulations suggest pandemics more likely in spring, early summer

October 19, 2017
New statistical simulations suggest that Northern Hemisphere flu pandemics are most likely to emerge in late spring or early summer at the tail end of the normal flu season, according to a new study published in PLOS Computational ...

H7N9 influenza is both lethal and transmissible in animal model for flu

October 19, 2017
In 2013, an influenza virus that had never before been detected began circulating among poultry in China. It caused several waves of human infection and in late 2016, the number of people to become sick from the H7N9 virus ...

New insights into herpes virus could inform vaccine development

October 18, 2017
A team of scientists has discovered new insights into the mechanisms of Epstein-Barr virus (EBV) infection, as well as two antibodies that block the virus' entry into cells. The findings, published in Proceedings of the National ...

Pair of discoveries illuminate new paths to flu and anthrax treatments

October 17, 2017
Two recent studies led by biologists at the University of California San Diego have set the research groundwork for new avenues to treat influenza and anthrax poisoning.

Portable 3-D scanner assesses patients with elephantiasis

October 17, 2017
An estimated 120 million people worldwide are infected with lymphatic filariasis, a parasitic, mosquito-borne disease that can cause major swelling and deformity of the legs, a condition known as elephantiasis. Health-care ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.