Abstract
Abstract Background and Aims MBD develops early in CKD and is associated with kidney damage progression, but CKD-MBD markers, of initial CKD-MBD like FGF23 and α-Klotho are not available in clinical practice. Recently ePTFp has been proposed as a new early marker of MBD. In fact, the progressive reduction of nephron number, with the proportional FGF23 increments, reduce renal tubular phosphate reabsorption to maintain phosphate balance. As a consequence, PTFp concentration per single nephron progressively increases, leading to progression of kidney tubular damage. For this reason, PTFp could represent an innovative early marker of CKD-MBD. We evaluated the relationship of ePTFp with FGF23, α-Klotho and kidney damage progression. Method In CKD stage G2-4, we assayed serum FGF23, α-Klotho and ePTFp [ePTFp = (Phosphaturia / creati-ninuria) x creatininemia x 3,33]. The progression of CKD was evaluated during 5 years and the patients were splitted in two groups according to the basal ePTFp median value. 30 healthy subject pro-vided the normal value of ePTFp. Results In 68 CKD patients (age 58,9 ± 15.6 y.o. eGFR 45 ± 21 mL/min), ePTFp averaged 2.4±1.3 mg/mg which was higher than the control group (ePTFp = 1.2±0.5; p<.01). ePTFp increased progressively along with the increasing CKD stages with values higher than the control group since stage 2 (Table 1). ePTFp showed a positive correlation with FGF23 (r: 0.69; p<.001) and a negative correlation with α-Klotho (r:-237; p<.05) and eGFR (r:-647; p<.001). Follow-up was available in 30 patients (Table 2) and showed a greater reduction of eGFR in the 15 patient with higher ePTFp (threshold 2 mg/dl) (Fig. 1). Conclusion Our data show early and progressive increments of ePTFp in CKD along with increments of FGF23 and PTH and reduction of α-Klotho, as per reciprocal pathophysiologic dependence. ePTFp values > than 2 mg/dl identified patients at highest risk of CKD progression. Accordingly, ePTFp, a surrogate of renal tubular cells phosphate overload, could represent a novel marker of CKD-MBD development and of increased risk of kidney damage potentially helpful to make therapeutic choice.
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