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Open AccessArticle

Associations of Calcium from Food Sources versus Phosphate Binders with Serum Calcium and FGF23 in Hemodialysis Patients

1
Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
2
Department of Nephrology, The Scarborough Hospital, Scarborough, ON M1P 2V5, Canada
3
Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
4
Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
5
Department of Medicine, AORN “Antonio Cardarelli”, 80231 Neaples, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(10), 1680; https://doi.org/10.3390/jcm8101680
Received: 4 September 2019 / Revised: 4 October 2019 / Accepted: 11 October 2019 / Published: 14 October 2019
(This article belongs to the Section Nephrology & Urology)
Background: Dysregulated serum calcium and FGF23 are associated with increased mortality and morbidity rates in patients receiving hemodialysis. Preliminary data suggest serum calcium regulates FGF23 secretion independently of serum phosphate, parathyroid hormone, and 25-OH vitamin D. It is unclear to what extent dietary and prescription sources of calcium influence calcium and FGF23 levels, and whether they confound this relationship. In this cross-sectional analysis of a multi-ethnic cohort of prevalent hemodialysis patients, association of dietary calcium and prescribed calcium were examined against serum calcium and FGF23. Bi- and multivariable linear regression was used for all analyses. Results: 81 patients (mean age 58 years, dialysis vintage 2 years, 51 men) participated. Dietary calcium was inversely associated with FGF23 (p = 0.04) however association of FGF23 with prescribed calcium did not reach statistical significance (0.08). In multivariable models, dietary calcium and prescribed calcium were associated in opposing directions with serum calcium (prescribed calcium; ß-coefficient = −0.35, p = 0.005 versus dietary calcium; ß-coefficient = 0.35, p = 0.03). FGF23 was independently associated with serum calcium (p = 0.007). Conclusions: We found differing, sometimes opposing, associations between serum calcium and FGF23 levels when considering prescribed versus dietary sources of calcium. Serum calcium and FGF23 were strongly correlated regardless of possible confounders examined in this hemodialysis cohort. Dietary calcium was associated with higher serum calcium and lower FGF23 concentrations, while prescribed calcium was only inversely associated with serum calcium. Further studies are required to confirm these associations and determine causality. View Full-Text
Keywords: fibroblast growth factor 23 (FGF23); calcium balance; dietary calcium; calcium supplements, serum calcium fibroblast growth factor 23 (FGF23); calcium balance; dietary calcium; calcium supplements, serum calcium
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Mahdavi, S.; Bellasi, A.; Nagra, K.; Johnston, L.; Tam, P.; Di Iorio, B.; Sikaneta, T. Associations of Calcium from Food Sources versus Phosphate Binders with Serum Calcium and FGF23 in Hemodialysis Patients. J. Clin. Med. 2019, 8, 1680.

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