대한신장학회

논문분류	춘계학술대회 초록집
제목	The impact of albuminuria on serum phosphate level via modulating tubular reabsorption in chronic kidney disease : result from the KNOW-CKD study
저자	Hyoungnae KIM1, Min-uk CHA1, Misol LEE1, Ki heon NAM1, Seong yeong AN1, Jong hyun JHEE1, Seohyun PARK1, Hae-ryong YUN1, Youn kyung KEE1, Tae IK2, Jung tak PARK1, Seung hyeok HAN1, Shin-wook KANG1,3, Kyu hun CHOI1, *Taehyun YOO1
출판정보	2017; 2017(1):
키워드	albuminuria, phosphate, FGF-23, chronic kidney disease
초록	Objectives : Both albuminuria and hyperphosphatemia are powerful risk factor of cardiovascular mortality in patients with chronic kidney disease (CKD). A recent experimental study demonstrated that albuminuria increases in serum phosphate level by increasing tubular reabsorption of phosphate via enhancing activity of sodium-phosphate co-transporter in proximal tubule and reduced activity of fibroblast growth factor 23 (FGF-23). The aim of this study was to evaluate the relationship between albuminuria and phosphate reabsorption in adult CKD patients. Methods : We examined 2207 patients who were enrolled in the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease. Tubular maximum reabsorption of phosphate to glomerular filtration rate (TmP/GFR) was calculated using serum and urine phosphate and creatinine values. Serum intact parathyroid hormone (iPTH), FGF-23 and other parameters of phosphate handling were also measured in study subjects. Results : The mean age was 52.7±12.3 years, and 1,350 (61.2%) were male. The average estimated glomerular filtration rate (eGFR) was 50.4±30.3 mL/min/1.73m2. When we categorized patients by serum phosphate quartiles, the amount of albuminuria, FGF-23 and iPTH levels were progressively increased according to increasing serum phosphate quartiles. In addition, TmP/GFR was paradoxically increased in high phosphate quartiles. In propensity score matching analysis by age, sex, eGFR and co-morbidities, patients in the macro-albuminuria group had significantly higher levels of phosphate (P < 0.001) and TmP/GFR (P = 0.02) compared to those in patients without macroalbuminuria, whereas FGF-23 and iPTH level were not different between the two groups. In multivariate linear regression analysis, FGF-23 was significantly associated with TmP/GFR in the group without macroalbuminuria (β = -0.051, P = 0.001), whereas such relationship was not observed in the macroalbuminuria group. (β= -0.015, P = 0.33). Conclusions : Present study demonstrated that overt albuminuria affects the serum phosphate level through tubular capacity of phosphate reabsorption in chronic kidney disease. Our study can support the pathophysiologic mechanism of phosphate retention, which urinary protein loss reduces the phosphaturic effect of FGF-23 in patients with macroalbuminuria.
원문(PDF)	PDF 원문보기

간행물 검색

대한신장학회 회원관리 규정