Monitoring Hormone May Improve Kidney Failure Outcomes
Submitted by Pratyesh m. Somani on Fri, 09/05/2008 - 17:39.
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Monitoring levels of a hormone called fibroblast growth factor 23 (FGF-23) may help improve treatment of kidney failure patients, say Massachusetts General Hospital researchers. Their analysis of patient data revealed that those who had elevated levels of FGF-23 when they began hemodialysis were much more likely to die within the first year of treatment, regardless of other risk factors. Patients with the highest FGF-23 levels had a 600 percent higher death rate than those with the lowest levels. Patients with intermediate FGF-23 levels also had an increased risk of death.1
FGF-23 helps regulate serum phosphate levels; and we know that, among patients with kidney failure, elevated phosphate is associated with more rapid progression to renal failure and earlier death. To determine whether an increase in serum FGF-23 was associated with the risk of death, the MGH researchers analyzed levels of both phosphate and FGF-23 in a large group of dialysis patients. Starting with data on more than 10,000 patients who began dialysis at more than 1,000 centers across North America, they examined the relationship between phosphate levels and the risk of death within the year after dialysis began and confirmed that mortality was modestly higher in those with the highest phosphate levels. They then compared serum FGF-23 levels of 200 patients who died during that first year with the levels of 200 patients who survived. To ensure that the effects of FGF-23 could be analyzed separately from those of phosphate, those 400 patients were selected to be equally balanced across the spectrum of serum phosphate levels.2
Incorporating FGF-23 levels into the management of kidney failure may have its greatest potential for treatment of the millions of patients with early-stage kidney disease who do not yet require dialysis, who usually have normal phosphate levels but quite high FGF-23.3
Routinely monitoring FGF-23 may help determine which patients need to begin therapies that control phosphate levels, which may reduce mortality in this very high-risk group.4 1. http://www.medicinenet.com/script/main/art.asp?articlekey=91642