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Relationship between Plasma Fibroblast Growth Factor-23 Concentration and Bone Mineralization in Children with Renal Failure on Peritoneal Dialysis

Departments of Pediatrics (K.W.-P., R.C.P., B.G., I.B.S.) and Biomathematics (H.W., R.M.E.), David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California 90095; Department of Pediatrics (S.S.), Loma Linda University, Loma Linda, California 92354; and Department of Pediatrics (H.J.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02115

Address all correspondence and requests for reprints to: Katherine Wesseling-Perry, Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, A2-383 MDCC, 10833 LeConte Boulevard, Los Angeles, California 90095. E-mail: kwesseling{at}mednet.ucla.edu.

Context: Fibroblast growth factor (FGF)-23 is produced in bone, and circulating levels are markedly elevated in patients with end-stage kidney disease, but the relationship between plasma levels of FGF-23 and bone histology in dialysis patients with secondary hyperparathyroidism is unknown.

Objective: The aim of the study was to evaluate the correlation between plasma levels of FGF-23 and bone histology in pediatric patients with end-stage kidney disease who display biochemical evidence of secondary hyperparathyroidism.

Design: We performed a cross-sectional analysis of the relationship between plasma FGF-23 levels and bone histomorphometry.

Setting: The study was conducted in a referral center.

Study Participants: Participants consisted of forty-nine pediatric patients who were treated with maintenance peritoneal dialysis and who had serum PTH levels (1st generation Nichols assay) greater than 400 pg/ml.

Intervention: There were no interventions.

Main Outcome Measure: Plasma FGF-23 levels and bone histomorphometry were measured.

Results: No correlation existed between values of PTH and FGF-23. Bone formation rates correlated with PTH (r = 0.44; P < 0.01), but not with FGF-23. Higher FGF-23 concentrations were associated with decreased osteoid thickness (r = –0.49; P < 0.01) and shorter osteoid maturation time (r = –0.48; P < 0.01).

Conclusions: High levels of FGF-23 are associated with improved indices of skeletal mineralization in dialyzed pediatric patients with high turnover renal osteodystrophy. Together with other biomarkers, FGF-23 measurements may indicate skeletal mineralization status in this patient population.

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