Abstract
Background and objectives: Chronic kidney disease (CKD) in children is a complex medical and social issue around the world. One of the serious complications is mineral-bone disorder (CKD-MBD) which might determine the prognosis of patients and their quality of life. Fibroblast growth factor 23 (FGF-23) is a phosphaturic hormone which is involved in the pathogenesis of CKD-MBD. The purpose of the study was to determine what comes first in children with CKD: FGF-23 or phosphate. Materials and Methods: This cross-sectional study included 73 children aged 2–18 years with CKD stages 1–5. We measured FGF-23 and other bone markers in blood samples and studied their associations. Results: Early elevations of FGF-23 were identified in children with CKD stage 2 compared with stage 1 (1.6 (1.5–1.8) pmol/L versus 0.65 (0.22–1.08), p = 0.029). There were significant differences between the advanced stages of the disease. FGF-23 correlated with PTH (r = 0.807, p = 0.000) and phosphate (r = 0.473, p = 0.000). Our study revealed that the elevated level of FGF-23 went ahead hyperphosphatemia and elevated PTH. Thus, more than 50% of children with CKD stage 2 had the elevating level of serum FGF-23, and that index became increasing with the disease progression and it achieved 100% at the dialysis stage. The serum phosphate increased more slowly and only 70.6% of children with CKD stage 5 had the increased values. The PTH increase was more dynamic. Conclusions: FGF-23 is an essential biomarker, elevates long before other markers of bone metabolism (phosphate), and might represent a clinical course of disease.
Highlights
Nowadays, chronic kidney disease (CKD) has become a great medical and social problem in the health care system due to its very high morbidity and mortality both in Kazakhstan and around the world
It is well known that mineral and bone disorder (CKD-MBD) is one of the most serious complications, which might result in cardiovascular events, and might worsen the prognosis for patients [1,6]
We found that 28.8% of children had delay of growth and development, which is a real medical and social problem in children with CKD
Summary
Chronic kidney disease (CKD) has become a great medical and social problem in the health care system due to its very high morbidity and mortality both in Kazakhstan and around the world. The prevalence of CKD among populations both in Europe and Asia accounts over 10% and the number of patients is increasing gradually [1,2,3]. As reported in one study, the incidence of CKD in the pediatric population is approximately 11–12 per million of age-related population (pmarp) for stages 3–5, while the prevalence is about. According to Kanatbayeva, in Kazakhstan, the incidence and the prevalence of CKD among children and adolescents is higher than on average in the world [5]. As for children, there is an additional problem of growth and skeletal deformities because of calcium and phosphate metabolism disturbances [7,8]
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