Effects of lower versus higher phosphate diets on fibroblast growth factor-23 levels in patients with chronic kidney disease: A systematic review and meta-Analysis

Wan Chuan Tsai, Hon Yen Wu, Yu Sen Peng, Shih Ping Hsu, Yen Ling Chiu, Hung Yuan Chen, Ju Yeh Yang, Mei Ju Ko, Mei Fen Pai, Yu Kang Tu, Kuan Yu Hung, Kuo Liong Chien

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

Abstract

Background Elevated fibroblast growth factor-23 (FGF23) levels increase the risk of cardiovascular diseases in patients with chronic kidney disease (CKD). We aimed to compare the effects of different dietary interventions, lower versus higher phosphate levels, on FGF23 in patients with CKD. Methods We conducted electronic literature searches of Medline, PubMed, Embase and the Cochrane Library for publications up to 29 October 2016 for randomized clinical trials that compared lower versus higher phosphate dietary interventions in adults with CKD. The primary outcome was the difference in change-from-baseline FGF23 levels between intervention groups. Considering the difference in measurement units between intact FGF23 and C-Terminal FGF23 assays, the treatment effect was analysed as the standardized mean difference (SMD) with the 95% confidence interval (CI). Results We identified five trials enrolling a total of 94 normophosphataemic patients with Stage 3B CKD. The study duration ranged from 1 to 12 weeks. Compared with higher phosphate diets, lower phosphate diets tended to reduce FGF23 levels (SMD â '0.74, 95% CI â '1.54 to 0.07, P = 0.07). Subgroup analyses showed a trend (P for interaction = 0.09) towards a better FGF23-lowering effect by lower phosphate diets in studies using the intact FGF23 assay (SMD â '1.14, 95% CI â '2.24 to â '0.04) than those using the C-Terminal FGF23 assay (SMD â '0.05, 95% CI â '0.67 to 0.57). Conclusions Short-Term dietary phosphate restriction tends to reduce FGF23 levels in patients with moderately decreased kidney function, and the FGF23-lowering effects tend to be more prominent when measured with the intact FGF23 assay.

Original languageEnglish
Pages (from-to)1977-1983
Number of pages7
JournalNephrology Dialysis Transplantation
Volume33
Issue number11
DOIs
Publication statusPublished - Nov 1 2018
Externally publishedYes

Keywords

  • chronic kidney disease
  • dietary intervention
  • fibroblast growth factor-23
  • meta-Analysis
  • phosphate

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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