Table 6.
Potential applications of FGF23 measurement in clinical nephrology
| Application | Example |
|---|---|
| Diagnostic | Early biochemical detection of the CKD-MBD; renal dysfunction (e.g., tubulointerstitial injury) |
| Risk stratification | CV: cardiac dysfunction, LVH, and death; high risk: high FGF23/low FEP/low 1,25(OH)2D; renal: rapid progressors (eGFR decline>3–5 ml/min per year), ESRD, and requirement for RRT; high risk: high FGF23/low 25(OH)D |
| Therapeutic selectiona | Early CKD: noncalcium-based oral P binders plus low P dietary prescription; vitamin D therapy; ACEi/ARB; advanced CKD: calcimimetic use or concurrent calcimimetic plus low-dose VDRA; postrenal transplantation; P/calcitriol supplementation |
| Monitor therapeutic response | As above; limit VDRA dose |
CKD-MBD, CKD–mineral bone disorder; CV, cardiovascular; P, phosphate; ACEi/ARB, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker; VDRA, vitamin D receptor activator.
a
In addition to standard indications.