medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-17-65-68medsovet-7112Research ArticleКОМОРБИДНЫЙ ПАЦИЕНТCOMORBID PATIENTВлияние терапии фосфат-связывающими препаратами на уровень FGF-23 у диализных пациентовEffect of phosphate binder therapy on FGF-23 levels in dialysis patientshttps://orcid.org/0000-0002-0691-8264РиндА. Р.RindA. R.

аспирант кафедры нефрологии и диализа, 

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Postgraduate Student of the Department of Nephrology and Dialysis,

6–8, Lev Tolstoy St., St Petersburg, 197022

anastasiia.rind@gmail.comhttps://orcid.org/0000-0002-7202-3151ЕсаянА. М.EssaianA. M.

д.м.н., профессор, заведующий кафедрой нефрологии и диализа,

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Dr. Sci. (Med.), Professor, Head of the Department of Nephrology and Dialysis,

6–8, Lev Tolstoy St., St Petersburg, 197022

essaian.ashot@gmail.comhttps://orcid.org/0000-0002-7605-4369ЗарайскийМ. И.ZaraiskiiM. I.

д.м.н., профессор кафедры клинической лабораторной диагностики,

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Dr. Sci. (Med.), Professor, Department of Clinical Laboratory Diagnostics, 

6–8, Lev Tolstoy St., St Petersburg, 197022

mzaraiski@yandex.ruПервый Санкт-Петербургский государственный медицинский университет имени академика И.П. ПавловаРоссияFirst Saint Petersburg State Medical UniversityRussian Federation2022121020220176568Copyright © Ринд А.Р., Есаян А.М., Зарайский М.И., 20222022Ринд А.Р., Есаян А.М., Зарайский М.И.Rind A.R., Essaian A.M., Zaraiskii M.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7112Введение

Введение. Фактор роста фибробластов 23-го типа (FGF-23) подавляет реабсорбцию фосфатов и синтез гормона витамина Д в почках. Известна связь уровня FGF-23 и сывороточного фосфата, а также прямая корреляция между гиперфосфатемией и риском сердечно-сосудистых событий.

Цель

Цель. Оценить ассоциации между уровнями FGF-23 в сыворотке крови с показателями костно-минерального обмена у пациентов на заместительной почечной терапии (ЗПТ) гемо- и перитонеальным диализом, получающих и не получающих фосфат-связывающие препараты.

Материалы и методы

Материалы и методы. В исследование было включено 65 пациентов, из которых 43 получали терапию программным гемодиализом, 22  — перитонеальным диализом. Группу контроля составили 28  здоровых добровольцев, 21  пациент получал лечение фосфат-связывающими препаратами. Из всех пациентов, получающих лечение, направленное на коррекцию гиперфосфатемии, 15 получали препарат севеламера карбонат в течение более 1 мес. согласно назначению лечащего врача.

Результаты

Результаты. У находящихся на хроническом гемодиализе пациентов увеличение концентрации FGF-23  в сыворотке крови коррелировало с продолжительностью пребывания на диализе (rs = 0,765; p = 0,04). Нами была выявлена прямая корреляция между концентрациями в сыворотке крови FGF-23 и неорганического фосфора (rs = 0,54; p = 0,03). В группе больных, получающих севеламера карбонат, отмечены более низкие уровни FGF-23 (12,4 ± 5,9) в отличие от группы, не  получавшей данный препарат  (23  ±  7,3; p = 0,003) и ПТГ  (110  ±  27  нг/мл, в группе, не получавшей препарат, – 340 ± 15; p = 0,01).

Выводы

Выводы. Уровень FGF-23  прямо коррелировал с «диализным стажем», уровнем паратгормона. Применение фосфатсвязывающих препаратов, в частности севеламера карбоната, ассоциируется с более низкими уровнями FGF-23 и ПТГ. 

Introduction

Introduction. Fibroblast growth factor type 23 (FGF-23) inhibits phosphate reabsorption and vitamin D hormone synthesis in the kidneys. There is a known relationship between FGF-23 levels and serum phosphate, as well as a direct correlation between hyperphosphatemia and the risk of cardiovascular events.

Aim

Aim. To evaluate associations between serum FGF-23 levels and bone and mineral metabolism in patients on renal replacement therapy (RRT) with hemo- and peritoneal dialysis, receiving and not receiving phosphate binders.

Materials and methods

Materials and methods. The study included 65 patients, of which 43 received maintenance hemodialysis tratment (HD), and  22 – peritoneal dialysis (PD). The control group consisted of 28 healthy volunteers.

Results

Results. The increase in the concentration of FGF-23 in the blood serum in patients on maintenance HD correlated with the vintage of dialysis treatment (rs = 0,765; p = 0,04). The positive correlation was found between the serum concentrations of FGF-23 and inorganic phosphorus (rs = 0,54; p = 0,03). The serum level of FGF-23 positively correlated with the serum PTH level (rs =  0,5; p = 0,01). In patients receiving sevelamer carbonate levels of  FGF-23  was lower, than in  control group (12.4 ± 5.9, and 23 ± 7.3, respectively; p = 0.003), as well as PTH (110 ± 27 ng/mL, and 340 ± 15, respectively; p = 0.01).

Conclusions

Conclusions. The level of FGF-23 in dialysis patients directly correlated with the serum level of PTH and “dialysis vintage”. The use of phosphate binders, in particular sevelamer carbonate, positively affects the expression of FGF-23 and PTH in dialysis patients. 

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The authors declare that there are no conflicts of interest present.