FGF-23 is a hormone linked to phosphate wasting in both animals and humans. S-FGF-23 levels are markedly elevated in patients with CKD but decline after renal transplantation. Phosphate retention is universal in dialyzed patients and wasting occurs after successful renal transplantation; however, the time course of decline of FGF-23 levels and its relationship to phosphate wasting in children have yet to be defined. Seventeen children ages 16.8 ± 0.6 years underwent renal transplantation. S-levels of FGF-23 (by intact and C-terminal assays), Ca, phos, and creatinine, as well as urine Ca, Phos, and creatinine, were measured at the time of transplant and daily post-transplant for 5 days. The coefficient of correlation between measurements of FGF-23 by the intact and C-terminal assays was r = .93 (p < .01). Intact FGF-23 correlated with s-creatinine (r = .43, p < .05) and s-phos (r = .35, p < .05) (Table 1). In the first 5 days after successful renal transplantation, s-FGF-23 levels decrease as s-Phos and decreases. The time course of decline in FGF-23 levels to near-normal range parallels that of serum creatinine, suggesting a predominant role for decreased renal clearance in its accumulation in dialyzed patients.
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