Journal Article

Mineral abnormalities and long-term graft function in pediatric renal transplant recipients: a role for FGF-23?

Katherine Wesseling-Perry, Eileen W. Tsai, Robert B. Ettenger, Harald Jüppner and Isidro B. Salusky

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 11, pages 3779-3784
Published in print November 2011 | ISSN: 0931-0509
Published online March 2011 | e-ISSN: 1460-2385 | DOI:
Mineral abnormalities and long-term graft function in pediatric renal transplant recipients: a role for FGF-23?

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Background. Although current guidelines recommend the evaluation of mineral and bone metabolism in patients with all stages of chronic kidney disease (CKD), the prevalence of altered mineral ion homeostasis in the pediatric posttransplant population is unknown. Moreover, the contribution of abnormal mineral ion metabolism to graft outcomes in this population has not been evaluated.

Methods. Serum calcium, phosphorus, 25(OH)vitamin D, 1,25(OH)2vitamin D, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) levels were evaluated 4.9 ± 0.5 years after transplantation in 68 stable pediatric renal allograft recipients. Patients were subsequently followed for 2 years.

Results. At baseline, mean estimated glomerular filtration rate (GFR) was 60 ± 2 mL/min/1.73m2. Serum calcium and phosphorus values were within the reference interval. PTH values were elevated but did not differ by CKD stage. 25(OH)vitamin D levels were low in nearly half of all subjects. Tubular reabsorption of phosphate and 1,25(OH)2vitamin D values were lower, while FGF-23 and PTH values were higher in more advanced stages of CKD. Thirty percent of patients with FGF-23 values >110 RU/mL had a decrease in GFR of >50% (P < 0.05) and FGF-23 values predicted future episodes of rejection.

Conclusions. Despite normal serum calcium and phosphorus levels in the majority of prevalent pediatric renal transplant recipients, abnormalities in PTH, 25(OH)vitamin D and FGF-23 are common. FGF-23 levels may be associated with increased risk for deterioration of kidney function and episodes of rejection.

Keywords: acute rejection; FGF-23; indices of mineral metabolism; pediatric renal transplantation; progression of renal failure

Journal Article.  4048 words.  Illustrated.

Subjects: Nephrology

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