ESPN 54th Annual Meeting

ESPN 2022


 
FGF23, systemic inflammation, muscle and protein energy wasting in children with chronic kidney disease
VASILIKI KARAVA 1 JOHN DOTIS 1 ANTONIA KONDOU 1 ATHANASIOS CHRISTOFORIDIS 2 ANNA TAPARKOU 3 EVANGELIA FARMAKI 3 NIKOLETA PRINTZA 1

1- PEDIATRIC NEPHROLOGY UNIT, 1ST DEPARTMENT OF PEDIATRICS, HIPPOKRATIO GENERAL HOSPITAL, ARISTOTLE UNIVERSITY OF THESSALONIKI, GREECE
2- PEDIATRIC ENDOCRINOLOGY UNIT, 1ST DEPARTMENT OF PEDIATRICS, HIPPOKRATIO GENERAL HOSPITAL, ARISTOTLE UNIVERSITY OF THESSALONIKI, GREECE
3- PEDIATRIC IMMUNOLOGY AND RHEUMATOLOGY REFERRAL CENTER, 1ST DEPARTMENT OF PEDIATRICS, HIPPOKRATIO GENERAL HOSPITAL, ARISTOTLE UNIVERSITY OF THESSALONIKI, GREECE
 
Introduction:

 This cross-sectional study investigates the association of fibroblast growth-factor 23 (FGF23) with systemic inflammation, muscle and protein energy wasting (PEW) in children with chronic kidney disease (CKD).
 

Material and methods:

 Serum calcium, phosphorus, 25(OH)D, intact parathormone, c-terminal FGF23, a-Klotho, albumin and IL-6 were measured in 53 patients from 5 to 19 years old with GFR<60 ml/min/1,73m2. PEW was defined as muscle wasting [lean tissue index adjusted to height age (LTI HA) z-score <-1.65 SD), measured by bioimpedance analysis spectroscopy, and at least two of the following: poor growth [height z-score <-1.88 SD], questionnaire based reduced appetite, serum albumin ≤ 3.8 g/dl.

Results:

LnFGF23 but not lnKlotho was correlated to LTI HA z-score (rs=-0.320, p=0.021) and lnIL-6 (rs=0.360, p=0.009) after adjustment for CKD stage. We performed logistic regression analysis of PEW criteria, including lnFGF23, lnIL-6, CKD stage and bone mineral parameters as covariates. LnFGF23 was significantly associated with muscle wasting (18 patients) (OR 2.763, 95% CI 1.246-6.124), while CKD stage and lnIL6 were significantly associated with poor growth (14 patients) (OR 9.178, 95% CI 1.346-62.582) and reduced albumin (13 patients) (OR 2.257, 95% CI 1.170-4.352) respectively. In backward logistic regression analysis, lnFGF23 was associated with PEW (8 patients) after adjustment for bone mineral parameters, lnIL-6 and CKD stage (OR 4.910, 95% CI 1.957-12.320).

Conclusions:

 Increased FGF23 may be associated with the muscle and PEW process in pediatric moderate and advanced CKD, independently of Klotho. FGF23 association with systemic inflammatory  may only in part explain our findings.