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Volume 79, Issue 12, Pages (June 2011)

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1 Volume 79, Issue 12, Pages 1370-1378 (June 2011)
Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease  Tamara Isakova, Patricia Wahl, Gabriela S. Vargas, Orlando M. Gutiérrez, Julia Scialla, Huiliang Xie, Dina Appleby, Lisa Nessel, Keith Bellovich, Jing Chen, Lee Hamm, Crystal Gadegbeku, Edward Horwitz, Raymond R. Townsend, Cheryl A.M. Anderson, James P. Lash, Chi-yuan Hsu, Mary B. Leonard, Myles Wolf  Kidney International  Volume 79, Issue 12, Pages (June 2011) DOI: /ki Copyright © 2011 International Society of Nephrology Terms and Conditions

2 Figure 1 Prevalence of hyperphosphatemia, secondary hyperparathyroidism, and elevated fibroblast growth factor 23 (FGF23) in relation to estimated glomerular filtration rate (eGFR). Hyperphosphatemia was defined as serum phosphate ≥4.6mg/dl, secondary hyperparathyroidism as parathyroid hormone (PTH) ≥65pg/ml, and FGF23 excess as FGF23 ≥100RU/ml. Kidney International  , DOI: ( /ki ) Copyright © 2011 International Society of Nephrology Terms and Conditions

3 Figure 2 Proportions of participants with normal or high fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH) levels within each estimated glomerular filtration rate (eGFR) category. Sections of pie charts indicate proportions of individuals with FGF23 and/or PTH abnormalities by eGFR category. White: normal PTH and FGF23 levels; yellow: high PTH/normal FGF23; gray: high FGF23/high PTH; and blue: high FGF23/normal PTH. CKD, chronic kidney disease. Kidney International  , DOI: ( /ki ) Copyright © 2011 International Society of Nephrology Terms and Conditions

4 Figure 3 Cubic spline functions of the associations of estimated glomerular filtration rate (eGFR) with log fibroblast growth factor 23 (FGF23) and with log parathyroid hormone (PTH). The shadowed areas represent 95% confidence intervals for the fitted splines. The red dotted lines represent the statistically significantly thresholds of eGFR at which the slopes increased. Tick marks on the x axis indicate individual observations at each level of eGFR. (a) logFGF23 versus eGFR and (b) logPTH versus eGFR. Kidney International  , DOI: ( /ki ) Copyright © 2011 International Society of Nephrology Terms and Conditions

5 Figure 4 Cubic spline functions of the associations between serum phosphate and log fractional excretion of phosphate (FEPi) with estimated glomerular filtration rate (eGFR). The shadowed areas represent 95% confidence intervals for the fitted splines. The red dotted line represents the statistically significantly threshold of eGFR at which the slope of serum phosphate changed. On the basis of this change, two phases of the phosphate curve are proposed. Kidney International  , DOI: ( /ki ) Copyright © 2011 International Society of Nephrology Terms and Conditions


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