The relative role of fibroblast growth factor 23 and parathyroid hormone in predicting future hypophosphatemia and hypercalcemia after living donor kidney transplantation: a 1-year prospective observational study

Nephrol Dial Transplant. 2011 Aug;26(8):2691-5. doi: 10.1093/ndt/gfq777. Epub 2011 Feb 8.


Background: Kidney transplantation (KTx) restores many of the disorders accompanying end-stage renal failure. However, hypercalcemia and hypophosphatemia are both common complications after renal transplantation. Prospective observation of these complications has not been well described and pre-transplant predictors also remain unknown. This prospective observational cohort study was carried out to clarify pre-transplant risk factors of persistent hypophosphatemia and/or hypercalcemia at 12 months after transplantation.

Methods: Consecutive living donor KTx recipients (n = 39) at Tokyo Women's Medical University were prospectively recruited. Parameters of bone and mineral metabolism including intact parathyroid hormone (iPTH) and full-length fibroblast growth factor (FGF) 23 were followed.

Results: FGF23 decreased to comparable levels for renal function while hyperparathyroidism persisted at 12 months after transplantation. Multivariate linear regression analysis revealed that pre-transplant iPTH correlated with hypercalcemia at 12 months and pre-transplant FGF23 was the best pre-transplant predictor of persistent hypophosphatemia at 12 months.

Conclusions: It is intriguing that although FGF23 is not a causal factor for hypophosphatemia at 12 months post-transplantation, it is a significant predictor of this common complication.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / metabolism*
  • Calcium / blood
  • Cohort Studies
  • Female
  • Fibroblast Growth Factors / blood*
  • Follow-Up Studies
  • Humans
  • Hypercalcemia / blood
  • Hypercalcemia / etiology*
  • Hyperparathyroidism / blood
  • Hyperparathyroidism / etiology
  • Hypophosphatemia / blood
  • Hypophosphatemia / etiology*
  • Kidney Failure, Chronic / therapy
  • Kidney Transplantation / adverse effects*
  • Living Donors*
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood*
  • Phosphates / blood
  • Prognosis
  • Prospective Studies


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