Relationship between plasma fibroblast growth factor-23 concentration and bone mineralization in children with renal failure on peritoneal dialysis

J Clin Endocrinol Metab. 2009 Feb;94(2):511-7. doi: 10.1210/jc.2008-0326. Epub 2008 Dec 2.


Context: Fibroblast growth factor (FGF)-23 is produced in bone, and circulating levels are markedly elevated in patients with end-stage kidney disease, but the relationship between plasma levels of FGF-23 and bone histology in dialysis patients with secondary hyperparathyroidism is unknown.

Objective: The aim of the study was to evaluate the correlation between plasma levels of FGF-23 and bone histology in pediatric patients with end-stage kidney disease who display biochemical evidence of secondary hyperparathyroidism.

Design: We performed a cross-sectional analysis of the relationship between plasma FGF-23 levels and bone histomorphometry.

Setting: The study was conducted in a referral center.

Study participants: Participants consisted of forty-nine pediatric patients who were treated with maintenance peritoneal dialysis and who had serum PTH levels (1st generation Nichols assay) greater than 400 pg/ml.

Intervention: There were no interventions.

Main outcome measure: Plasma FGF-23 levels and bone histomorphometry were measured.

Results: No correlation existed between values of PTH and FGF-23. Bone formation rates correlated with PTH (r = 0.44; P < 0.01), but not with FGF-23. Higher FGF-23 concentrations were associated with decreased osteoid thickness (r = -0.49; P < 0.01) and shorter osteoid maturation time (r = -0.48; P < 0.01).

Conclusions: High levels of FGF-23 are associated with improved indices of skeletal mineralization in dialyzed pediatric patients with high turnover renal osteodystrophy. Together with other biomarkers, FGF-23 measurements may indicate skeletal mineralization status in this patient population.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Biomarkers / blood
  • Bone Density / physiology
  • Calcification, Physiologic* / physiology
  • Calcium / blood
  • Child
  • Cross-Sectional Studies
  • Female
  • Fibroblast Growth Factors / blood*
  • Humans
  • Hyperparathyroidism, Secondary / blood
  • Hyperparathyroidism, Secondary / etiology
  • Hyperparathyroidism, Secondary / physiopathology
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Parathyroid Hormone / blood
  • Peritoneal Dialysis*
  • Vitamin D / blood
  • Young Adult


  • Biomarkers
  • Parathyroid Hormone
  • Vitamin D
  • Fibroblast Growth Factors
  • fibroblast growth factor 23
  • Calcium