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Vol. 33, No. 5, 2011
Issue release date: May 2011
Am J Nephrol 2011;33:421–426

Effect of Intravenous Saccharated Ferric Oxide on Serum FGF23 and Mineral Metabolism in Hemodialysis Patients

Takeda Y. · Komaba H. · Goto S. · Fujii H. · Umezu M. · Hasegawa H. · Fujimori A. · Nishioka M. · Nishi S. · Fukagawa M.
aDivision of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, bDivision of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, cDepartment of Nephrology and Blood Purification Center, Rokko Island Hospital, dDivision of Blood Purification and Kidney Center, Konan Hospital, and eSumiyoshigawa Clinic, Kobe, Japan

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Background/Aims: Fibroblast growth factor-23 (FGF23) plays a central role in the development of hypophosphatemia and inappropriately low 1,25-dihydroxyvitamin D induced by iron therapy for iron-deficiency anemia. The aim of this study was to examine the effect of intravenous saccharated ferric oxide on serum FGF23 levels and mineral metabolism in hemodialysis patients. Methods: This prospective study enrolled 27 hemodialysis patients who had iron-deficiency anemia defined by a hemoglobin concentration <10.5 g/dl and serum ferritin <100 ng/ml. Intravenous saccharated ferric oxide at a dose of 40 mg was administered three times weekly over 3 weeks. The dose of active vitamin D and phosphate binders was kept unchanged. Serum FGF23, intact parathyroid hormone (PTH) and other parameters were prospectively monitored for 5 weeks. Results: Serum FGF23 levels were markedly elevated [3,453 (338–6,383) pg/ml] at baseline. After 3 weeks of intravenous saccharated ferric oxide treatment, serum FGF23 further increased to 4,701 (1,251–14,396) pg/ml, and returned to the baseline values after 2 weeks of observation. There was also a significant decrease in intact PTH but no changes in serum calcium and phosphorus. Conclusions: Intravenous saccharated ferric oxide induces further increase in elevated FGF23 levels in hemodialysis patients. This increase does not induce hypophosphatemia and inappropriately low 1,25-dihydroxyvitamin D in the absence of functioning kidney, but may result in transient PTH suppression – possibly by directly acting on the parathyroid.

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