Effects of lanthanum carbonate and calcium carbonate on fibroblast growth factor 23 and hepcidin levels in chronic hemodialysis patients.

BACKGROUND: Phosphate binders have an impact on fibroblast growth factor 23 (FGF23); however, the effect of phosphate binders on serum hepcidin has not been explored. We conducted a 24-week multicenter randomized controlled trial to investigate the effects of lanthanum carbonate or calcium carbonate monotherapy on serum phosphate, FGF23, and hepcidin levels in chronic hemodialysis patients. METHODS: Forty-six patients were recruited, and daily dietary phosphorus was controlled between 600-800 mg. Serum calcium, phosphate, albumin, alkaline phosphatase (ALP), FGF23, intact parathyroid hormone (iPTH), hepcidin, high-sensitivity CRP (hsCRP), 25(OH)D, 1,25(OH)2D, fetuin-A, and osteopontin were checked as scheduled. RESULTS: Twenty-five patients completed the study. Mean serum FGF23 level was significantly decreased after a 24-week treatment with lanthanum (8677.5 ± 7490.0 vs. 4692.8 ± 5348.3 pg/mL, p = 0.013, n = 13), but not with calcium (n = 12). The reduction of serum hepcidin in lanthanum group was positively correlated with the decrement of serum phosphate (r = 0.631, p = 0.021) and serum hsCRP (r = 0.670, p = 0.012) levels, respectively. Serum ALP, iPTH, vitamin D, fetuin-A, and osteopontin revealed no significant inter- or intragroup differences. CONCLUSIONS: In summary, a decrease in serum FGF23 levels and a trend of decline in hepcidin levels were observed only in lanthanum group.

Clustering of unconventional cardiovascular risk factors among Taiwanese hemodialysis patients.

BACKGROUND: Cardiovascular disease (CAVD) is the most common cause of mortality for chronic hemodialysis (HD) patients, yet the risk factors for the events have not been well established. METHODS: We conducted a multicenter cross-sectional survey in 995 chronic HD patients recruited from 12 HD centers in Taiwan to investigate the prevalence of CAVD, including coronary heart disease (CHD), cerebrovascular disease (CVD), and peripheral vascular disease (PVD), and related them to 30 different parameters. RESULTS: The mean age of 995 patients (499 males/496 females) was 56.4 +/- 12.3 years, and average HD duration was 59.8 +/- 51.2 months. The prevalence rates of CHD, CVD, and PVD were 24.0, 6.0, and 5.3%, respectively. Results of our multivariate logistic regression analysis showed that out of the conventional CAVD risk factors, only old age and diabetes could be significantly associated with CAVD. Meanwhile, we found some novel clinical correlates, including low apolipoprotein A-I and creatinine for CHD, low uric acid for CVD, and low hematocrit and low diastolic blood pressure for PVD. Interestingly, left ventricular hypertrophy was found to be an independent correlate for all three: CHD, CVD, and PVD. CONCLUSIONS: Our study suggests that consideration of conventional cardiovascular risk factors as well as unconventional risk factors might better assess the risk for CAVD among HD patients.