FGF23 in chronic kidney disease and kidney post-transplant patients

Phosphatonins are regulatory factors of phosphate metabolism and the FGF23 is the best studied of them. This has produced a change in our understanding in mineral metabolism and specifically of phosphate regulation. FGF23 is a 251-amino acid factor that differs from other FGF family members by having a 71-amino acid extension on the carboxyl-terminal end of the molecule that is specific for this factor. It is primarily produced by osteocytes in bone. It has a central role in phosphate homeostasis regulation, producing phosphaturia, and in vitamin D metabolism, inhibiting its production by suppression of renal 1 Alfa hydroxylase. It is believed to have an important place in the pathogenesis of early secondary hyperparathiroidism related to chronic renal insufficiency by inhibiting renal synthesis of 1,25(OH)2D in response to its increment in blood produced to increase renal phosphate excretion and maintain phosphate balance. In CRF its serum levels seem to be independent predictors of progression to terminal renal failure. In dialysis patients the determination of its serum levels would allow to predict the results of therapy with calcitriol in the treatment of secondary hyperparathyroidism; they also seem to be independent predictors of the risk of mortality during the first year of hemodialysis. Its serum levels have also been related to the development of vascular calcifications of hand arteries but not with aortic calcifications. The exposure to excessive levels of FGF23 in the early postransplant period seems to be strongly associated with postransplant hypophophatemia more than to PTH or other phosphatonins.