What is the relationship between a fasting glucose level of 23 mmol/L (Fasting Glucose Serum (FGS)) and phosphate levels?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: May 2, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

For a patient with an fGS of 23, managing phosphate levels is crucial to prevent complications associated with chronic kidney disease (CKD). In patients with CKD stage G3a to G5D, treatment should focus on those with hyperphosphatemia, as suggested by the Kidney Disease: Improving Global Outcomes 2017 clinical practice guideline update 1. The goal is to prevent hyperphosphatemia, which may be valuable in patients with CKD stage G3a to G5D, especially those with elevated FGF23 levels. Some key points to consider in managing phosphate levels include:

  • Avoiding hypercalcemia in adult patients with CKD G3a to G5D, as higher calcium concentrations have been linked to increased mortality and nonfatal cardiovascular events 1.
  • Using a dialysate calcium concentration between 1.25 and 1.50 mmol/L (2.5 and 3.0 mEq/L) in patients with CKD G5D 1.
  • Maintaining normal serum calcium levels, while being cautious of the potential harm associated with a positive calcium balance in some cases 1. Regular monitoring of serum phosphate, calcium, and PTH levels is necessary to adjust treatment and prevent secondary hyperparathyroidism, bone mineral disorders, and vascular calcification. Dietary phosphate restriction to 800-1000 mg/day, focusing on limiting processed foods, dairy, and certain proteins, is also essential. First-line options for phosphate management include calcium-based binders like calcium acetate or calcium carbonate, as well as non-calcium options like sevelamer carbonate, lanthanum carbonate, or ferric citrate, which should be taken with food to bind dietary phosphate in the gut. By prioritizing phosphate management and monitoring, patients with CKD can reduce their risk of complications and improve their overall quality of life.

From the Research

FGF23 and Phosphate Relationship

  • FGF23 is a protein involved in mineral homeostasis, regulating phosphate levels in the body 2
  • Elevated FGF23 levels are associated with various pathologies, including X-linked hypophosphataemia, chronic kidney disease, and cardiovascular disease 2
  • FGF23 levels are regulated by dietary phosphorus, and high phosphate levels can lead to increased FGF23 production 3, 4

Effects of Phosphate Binders on FGF23

  • The use of non-calcium-based phosphate binders, such as sevelamer carbonate, may not significantly reduce FGF23 levels in patients with chronic kidney disease, despite reducing phosphate levels 3
  • Calcium-based phosphate binders, on the other hand, may be associated with higher FGF23 levels 5

FGF23 and Phosphate in Chronic Kidney Disease

  • FGF23 levels increase early in chronic kidney disease and are correlated with serum phosphate levels 5, 4
  • Reducing phosphate levels through dietary restriction or phosphate binders may help lower FGF23 levels in patients with chronic kidney disease 6
  • Elevated FGF23 and phosphate levels are associated with increased risks of end-stage renal disease, cardiovascular disease, and death in patients with chronic kidney disease 6

Therapeutic Approaches to Reduce FGF23 and Phosphate

  • Dietary phosphate restriction, phosphate binders, and vitamin B3 derivatives, such as niacin or nicotinamide, may be effective in reducing serum phosphate and FGF23 levels 6
  • Further research is needed to determine the optimal therapeutic approach to lowering FGF23 and phosphate levels in patients with chronic kidney disease 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

6
Research

Rationale and Approaches to Phosphate and Fibroblast Growth Factor 23 Reduction in CKD.

Journal of the American Society of Nephrology : JASN, 2015

Related Questions

What is the cause of thrombocytopenia (platelet count 80 x 10^9/L) in a 78-year-old female (YOF) patient on prophylactic Tinzaparin (dalteparin)?
What are the implications of a 23 week fetus (Fetal Gestational Age) with potential complications?
What adjustments should be made to the current intravenous (IV) fluid regimen for a patient with a history of diabetic ketoacidosis (DKA), who received 500ml of D10 (10% dextrose) and had a subsequent increase in blood glucose from hyperglycemia (10) to severe hyperglycemia (87), and is currently receiving D10 at 50ml/hr with a blood glucose level that has fluctuated from severe hyperglycemia (155) to hyperglycemia (113)?
Can the patient with a history of insomnia and Attention Deficit Hyperactivity Disorder (ADHD) be restarted on Ambien (zolpidem) and Trazodone (trazodone) for sleep management following an appendectomy for appendicitis?
Does Pradaxa (dabigatran) affect the Prothrombin Time (PT) or Activated Partial Thromboplastin Time (aPTT)?
What is the role of calcium acetate as a phosphate binder?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question