Tertiary 'hyperphosphatoninism' accentuates hypophosphatemia and suppresses calcitriol levels in renal transplant recipients

Am J Transplant. 2007 May;7(5):1193-200. doi: 10.1111/j.1600-6143.2007.01753.x. Epub 2007 Mar 12.


Hypophosphatemia and inappropriately low calcitriol levels are frequently observed following successful renal transplantation. Fibroblast growth factor-23 (FGF-23) is a recently characterized phosphaturic hormone that inhibits renal 1 alpha-hydroxylase activity and may be involved in the pathogenesis of both phenomena. The following hypotheses were tested: pretransplant FGF-23 predicts posttransplant FGF-23, FGF-23 predicts posttransplant hypophosphatemia and FGF-23 is associated with decreased calcitriol levels independent of renal and parathyroid function. Serum biointact parathyroid hormone (PTH), calcidiol, calcitriol, full-length FGF-23, calcium and phosphate were monitored in 41 renal transplant recipients at the time of transplantation (pre) and 3 months thereafter (post). In addition, serum phosphate nadir in each individual patient was identified and urinary fractional excretion of phosphate (FE(PO4)) at month 3 was calculated. High FGF-23(post) levels were independently associated with high FGF-23(pre), low calcitriol(post) and high calcium(post) levels. FGF-23, but none of the other mineral metabolism indices, was an independent predictor of the phosphate nadir in the early posttransplant period. A high FGF-23(post) level was independently associated with a high FE(PO4). High FGF-23(post) and creatinine levels and low PTH(post) levels were independently associated with low calcitriol(post) levels. In conclusion, our data indicate that persistence of FGF-23 contributes to hypophosphatemia and suboptimal calcitriol levels in renal transplant recipients.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Biomarkers / blood
  • Calcitriol / blood*
  • Calcitriol / physiology
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / blood*
  • Fibroblast Growth Factors / physiology
  • Humans
  • Hypophosphatemia / blood*
  • Hypophosphatemia / etiology
  • Hypophosphatemia / physiopathology
  • Kidney Transplantation / adverse effects*
  • Middle Aged
  • Minerals / metabolism
  • Parathyroid Hormone / blood
  • Parathyroid Hormone / physiology
  • Phosphates / blood*
  • Phosphates / physiology
  • Predictive Value of Tests
  • Prospective Studies
  • Vitamin D / physiology


  • Biomarkers
  • FGF23 protein, human
  • Minerals
  • Parathyroid Hormone
  • Phosphates
  • Vitamin D
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23
  • Calcitriol