Elevated FGF 23 and phosphorus are associated with coronary calcification in hemodialysis patients

Pediatr Nephrol. 2011 Jun;26(6):945-51. doi: 10.1007/s00467-011-1822-0. Epub 2011 Feb 27.


Increased mortality of adult chronic hemodialysis (HD) patients is associated with coronary calcifications (CC), increased serum phosphorus (P), use of calcium (Ca)-containing P-binders, and vitamin D deficiency. Serum concentration of fibroblast growth factor 23 (FGF 23) is markedly elevated in adults receiving dialysis and is independently associated with increased mortality. Although coronary calcifications have been described in pediatric and adult HD patients, no significant association between serum FGF 23 and CC has been reported. In our study, 5/16 patients had CC. Patients with CC were older, had longer dialysis vintage and higher serum P. Serum Ca, total PTH, elemental Ca intake, and calcitriol doses were not different for CC patients. Serum FGF 23 levels were markedly elevated in all patients (mean 4,024, range 874-8,253), but significantly higher in patients with CC (4,247 ± 10,35 vs 2,427 ± 11,92, p = 0.01) and positively correlated with Agatston calcification score (r = 0.69, p = 0.003) and serum P (r = 0.49, p = 0.05). Using multivariate analysis, serum FGF 23 and serum P remained the most significant factors associated with Agatston score. This study confirms the occurrence of CC in pediatric HD patients and is the first to show a significant association between CC and elevated serum FGF 23 in children.

MeSH terms

  • Adolescent
  • Age Factors
  • Calcinosis / diagnosis
  • Calcinosis / etiology*
  • Calcinosis / metabolism
  • Calcium / blood
  • Child
  • Chronic Kidney Disease-Mineral and Bone Disorder / etiology
  • Chronic Kidney Disease-Mineral and Bone Disorder / metabolism
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / etiology*
  • Coronary Artery Disease / metabolism
  • Female
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / blood*
  • Humans
  • Image Processing, Computer-Assisted
  • Male
  • Phosphorus / blood*
  • Renal Dialysis / adverse effects*
  • Time Factors
  • Tomography, X-Ray Computed
  • Young Adult


  • FGF23 protein, human
  • Phosphorus
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23
  • Calcium