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Observational Study
. 2025 Jul;89(1):250-258.
doi: 10.1007/s12020-025-04221-y. Epub 2025 Apr 16.

Obesity and blunted FGF23 response associate with kidney impairment in patients with hypoparathyroidism

Luigi di Filippo  1 , Agnese Allora  1 , Anna Maria Formenti  1 , Francesca Ferrari  1 , Marta Villanova  1 , Antonino Russo  2 , Barbara Presciuttini  3 , Massimo Locatelli  4 , Maria Luisa Brandi  1 , Giuseppe Vezzoli  5 , Claudio Marelli  6 , Andrea Giustina  7
Affiliations
Observational Study

Obesity and blunted FGF23 response associate with kidney impairment in patients with hypoparathyroidism

Luigi di Filippo et al. Endocrine. 2025 Jul.

Abstract

Purpose: Chronic kidney disease (CKD) is a common complication of patients affected by chronic hypoparathyroidism managed with conventional therapies. However, no data are currently available regarding the endocrine and metabolic determinants of renal function in these patients.

Methods: This was a multicenter observational study performed in three health-care centres. Patients with hypoparathyroidism were consecutively enrolled during follow-up visits in 2022-2023. These exclusion criteria were adopted: patients managed with dialysis, proteinuria (>200 mg/24 h), use of antihypertensive drugs including thiazides, ACE-inhibitors, angiotensin-II-receptor antagonists, alpha-beta blocking-agents, aldosterone-antagonists, and insulin-treated diabetes.

Results: A total of 46 patients were enrolled. Median age was 53 years, 34 (74%) were female and the median disease duration was 11 years. In all patients, the calcium-phosphate product was within the normal range. The 23.7% of patients was obese (BMI ≥ 30) and CKD (defined with an eGFR < 60 mL/min1.73m2) was found in the 21.7% of patients. Patients with CKD were older, affected by a longer-disease, more frequently obese and with higher BMI. In multivariate analyses, obesity resulted as the only significant independent risk factor associated with CKD. In addition, a significant negative correlation was found between BMI and eGFR, and ROC analyses showed a significant global-performances of BMI to predict CKD. Patients with CKD were characterized also by higher FGF23 levels. A significant negative correlation was found between FGF23 and eGFR, however, evaluating separately those with and without CKD, this correlation remained significant only in the second group.

Conclusions: For the first-time, obesity was demonstrated to be independently associated with CKD in patients with hypoparathyroidism, and a blunted eGFR-related response of FGF23 was shown in patients with CKD potentially worsening the renal function in the context of hypoparathyroidism.

Keywords: Chronic kidney disease; FGF23; Hypoparathyroidism; Obesity; Vitamin D.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: Disclosures: Andrea Giustina is consultant for Abiogen and received research grant to Institution from Takeda. All other authors have no conflict of interest to declare. The Work submitted for publication is original and has not been published in any language or format and has not been submitted elsewhere for print or electronic publication consideration.

Figures

Fig. 1
Fig. 1
Negative linear correlation between BMI and eGFR in patients with hypoPT
Fig. 2
Fig. 2
Correlation and receiver operating characteristic (ROC) analysis and area under the receiver operating characteristic curve (AUROC) of BMI to predict CKD in patients with hypoPT
Fig. 3
Fig. 3
Negative linear correlation between eGFR and FGF23 in patients with hypoPT
See this image and copyright information in PMC

References

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