The Effect of Early Targeting Fibroblast Growth Factor 23 and Microalbuminuria by Using Phosphate Binders in Diabetic Nephropathy Deterioration

Background: Diabetic nephropathy consists of major pathology for deterioration of chronic kidney disease. Microalbuminuria and fibroblast growth factor 23 (FGF23) reflects an early marker for kidney disease deterioration. Kidney Disease Improving Global Outcomes (KDIGO) restrict the use of phosphate binder (PB) for hyperphosphatemia that manifested at late stages only. Objective: To study the effect of early treatments of PBs in normophosphatemic diabetic nephropathic patients. Material and methods: A Randomized control trial was conducted during the period December 2016 to October 2017, including 75 patients with chronic kidney disease. Patients were assigned into three groups according to the type of treatment. The primary end points were the effects of intervention on serum fibroblast growth factor and urinary albumin creatinine ratio. Results: Both phosphate binders significantly reduced serum phosphate at similar extent with significant reduction in serum fibroblast growth factor 23. Sevelamer showed pleiotropic effect beyond phosphate control that reduces HBA1c and plasma glucose level with antiproteinuric effect. In both treatment arms, serum creatinine was reduced but the differences did not reach the statistical significance (p>0.05). Conclusion: Thus, early intervention with calcium carbonate and sevelamer reduce disease progression by earlier control of FGF23 level. Maximal beneficial effect was noticed by early use of sevelamer HCl supported by reduction in UACR and more glycemic control in early stage of diabetic nephropathy