New Aspects of the Kidney in the Regulation of Fibroblast Growth Factor 23 (FGF23) and Mineral Homeostasis

The bone-derived hormone fibroblast growth factor 23 (FGF23) acts in concert with parathyroid hormone (PTH) and the active vitamin D metabolite calcitriol in the regulation of calcium (Ca) and phosphate (P) homeostasis. More factors are being identified to regulate FGF23 levels and the endocrine loops between the three hormones. The present review summarizes the complex regulation of FGF23 and the disturbed FGF23/Klotho system in chronic kidney disease (CKD). In addition to the reduced ability of the injured kidney to regulate plasma levels of FGF23, several CKD-related factors have been shown to stimulate FGF23 production. The high circulating FGF23 levels have detrimental effects on erythropoiesis, the cardio-vascular system and the immune system, all contributing to the disturbed system biology in CKD. Moreover, new factors secreted by the injured kidney and the uremic calcified vasculature play a role in the mineral and bone disorder in CKD and create a vicious pathological crosstalk.

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SUN-078 CLINICAL UTILITY AND CORRELATES OF SERUM FIBROBLAST GROWTH FACTOR-23 AS A BIOMARKER OF MINERAL AND BONE DISORDER IN PATIENTS WITH PRE-DIALYSIS CHRONIC KIDNEY DISEASE

Kidney International Reports ◽

10.1016/j.ekir.2020.02.604 ◽

2020 ◽

Vol 5 (3) ◽

pp. S234

Author(s):

K. BUSARI ◽

T. Olanrewaju ◽

D. Oyedepo ◽

A. Faponle ◽

S. Biliaminu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Growth Factor ◽

Kidney Disease ◽

Fibroblast Growth Factor ◽

Clinical Utility ◽

Fibroblast Growth Factor 23 ◽

Fibroblast Growth ◽

Mineral And Bone Disorder ◽

Bone Disorder

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Minireview: Fibroblast Growth Factor 23 in Phosphate Homeostasis and Bone Metabolism

Endocrinology ◽

10.1210/en.2010-0800 ◽

2011 ◽

Vol 152 (1) ◽

pp. 4-10 ◽

Cited By ~ 52

Author(s):

Michiko Hori ◽

Yuichiro Shimizu ◽

Seiji Fukumoto

Keyword(s):

Chronic Kidney Disease ◽

Growth Factor ◽

Bone Metabolism ◽

Fibroblast Growth Factor ◽

Fibroblast Growth Factor 23 ◽

Phosphate Metabolism ◽

Fibroblast Growth ◽

Phosphate Homeostasis ◽

Mineral And Bone Disorder ◽

Bone Disorder

Abstract Fibroblast growth factor 23 (FGF23) was identified in 2000. Since then, FGF23 has been found to physiologically regulate phosphate metabolism and aberrant actions of FGF23 results in several disorders of phosphate and bone metabolism. In addition, FGF23 plays an important role in the development of chronic kidney disease–mineral and bone disorder. However, further investigations are necessary, especially with regard to the regulation of FGF23 expression. In this minireview, we focus on the physiological and pathophysiological significance of FGF23 in phosphate and bone metabolism.

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Fibroblast Growth Factor 23 and Adverse Clinical Outcomes in Type 2 Diabetes: a Bitter-Sweet Symphony

Current Diabetes Reports ◽

10.1007/s11892-020-01335-7 ◽

2020 ◽

Vol 20 (10) ◽

Author(s):

Stanley M. H. Yeung ◽

Stephan J. L. Bakker ◽

Gozewijn D. Laverman ◽

Martin H. De Borst

Keyword(s):

Type 2 Diabetes ◽

Growth Factor ◽

Fibroblast Growth Factor ◽

Kidney Function ◽

Fibroblast Growth Factor 23 ◽

Adverse Outcomes ◽

Fibroblast Growth ◽

Antidiabetic Medication ◽

Related Factors

Abstract Purpose of Review Fibroblast growth factor 23 (FGF23) is a key phosphate-regulating hormone that has been associated with adverse outcomes in patients with chronic kidney disease (CKD). Emerging data suggest that FGF23 plays a specific role in type 2 diabetes, partly independent of kidney function. We aimed to summarize current literature on the associations between FGF23 and outcomes in patients with type 2 diabetes with or without CKD. Recent Findings Several cohort studies have shown strong associations between plasma FGF23 and cardiovascular outcomes in diabetic CKD. Moreover, recent data suggest that FGF23 are elevated and may also be a risk factor for cardiovascular disease and mortality in type 2 diabetes patients without CKD, although the magnitude of the association is smaller than in CKD patients. Summary Diabetes-related factors may influence plasma FGF23 levels, and a higher FGF23 levels seem to contribute to a higher cardiovascular and mortality risk in patients with type 2 diabetes. Although this risk may be relevant in diabetic individuals with preserved kidney function, it is strongly accentuated in diabetic nephropathy. Future studies should clarify if FGF23 is merely a disease severity marker or a contributor to adverse outcomes in type 2 diabetes and establish if antidiabetic medication can modify FGF23 levels.

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