Anemia and Mineral Bone Disorder in Kidney Disease Patients: The Role of FGF-23 and Other Related Factors

Int J Mol Sci. 2024 Nov 29;25(23):12838. doi: 10.3390/ijms252312838.

Abstract

Anemia and mineral and bone disorder (MBD) are significant complications of chronic kidney disease (CKD). The erythropoietin (Epo) pathway plays a key role in both of these processes in CKD. Another molecule that plays an important role in CKD-MBD is fibroblast growth factor (FGF)-23, whose main role is to maintain serum phosphate levels in the normal range, acting via its co-receptor Klotho; however, its activity may also be related to anemia and inflammation. In this review, the regulation of Epo and FGF-23 and the molecular mechanisms of their action are outlined. Furthermore, the complex interaction between EPO and FGF-23 is discussed, as well as their association with other anemia-related factors and processes such as Klotho, vitamin D, and iron deficiency. Together, these may be part of a "kidney-bone marrow-bone axis" that promotes CKD-MBD.

Keywords: ESKD; Klotho; anemia; chronic kidney disease; erythropoietin; mineral bone disorder.

Publication types

  • Review

MeSH terms

  • Anemia* / etiology
  • Anemia* / metabolism
  • Animals
  • Bone Diseases, Metabolic / etiology
  • Bone Diseases, Metabolic / metabolism
  • Chronic Kidney Disease-Mineral and Bone Disorder / etiology
  • Chronic Kidney Disease-Mineral and Bone Disorder / metabolism
  • Erythropoietin / metabolism
  • Fibroblast Growth Factor-23* / metabolism
  • Fibroblast Growth Factors* / metabolism
  • Glucuronidase / metabolism
  • Humans
  • Klotho Proteins / metabolism
  • Renal Insufficiency, Chronic* / complications
  • Renal Insufficiency, Chronic* / metabolism
  • Vitamin D / metabolism

Substances

  • Fibroblast Growth Factor-23
  • FGF23 protein, human
  • Fibroblast Growth Factors
  • Klotho Proteins
  • Erythropoietin
  • Glucuronidase
  • Vitamin D

Grants and funding

This research received no external funding.