The Impact of Phosphate Metabolism on Healthy Aging

Study Overview
=================
Brief Summary
-----------------
Determine the association between duration and dose of chronic conventional therapy with Pi and renal (nephrocalcinosis/nephrolithiasis), vascular (endothelial function), and cardiovascular function (echo- cardiography) in patients with hereditary hypophosphatemic rickets with hypercalciuria (HHRH) and patients with X-linked hypophosphatemia (XLH).

Detailed Description
-----------------
The central hypothesis of this proposal is that patients with X-linked hypophosphatemia (XLH), when matched for duration and dose of phosphate (Pi) therapy to patients with hereditary hypophosphatemic rickets with hypercalciuria (HHRH), will evidence greater cardiovascular and vascular debility than patients with HHRH. The overall objectives of this project are to utilize our existing longitudinal databases for individuals with XLH and HHRH through an interdisciplinary collaboration between pediatric and adult endocrinology to: i) quantify the impact of exposure to Pi therapy across the lifespan on cardiovascular and renal complications, which are key aging endpoints, ii) determine the acute response to Pi loading in XLH and HHRH by studying the changes in surrogate markers of cardiovascular and renal function.

Official Title
-----------------
The Impact of Phosphate Metabolism on Healthy Aging

Conditions
-----------------
Hypophosphatemia, Rickets, Hypercalciuria, XLH, HHRH

Intervention / Treatment
-----------------
* Drug: phosphate


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Children above the age of 13 years Younger and older adults with XLH and HHRH with confirmed NPT2c mutations affecting both copies of the NPT2c gene (HHRH) or one copy of the PHEX gene (XLH) Be willing to provide access to prior medical records to determine eligibility including imaging, biochemical, medical, and surgical history data Be willing and able to complete all aspects of the study Be willing to adhere to the study visit schedule and comply with the assessments (in the opinion of the investigator). Exclusion Criteria: Subjects will be excluded, if they are children younger than age 13 years Subjects that have other diseases likely to impact bone and mineral metabolism (e.g. renal, hepatic, gastrointestinal disorders, and malignancy), Subjects that are currently pregnant, Subjects that received medical therapy or developed any condition, which in the opinion of the investigator, could present a concern for either subject safety or difficulty with data interpretation. Subjects will be excluded from Aim 2, if they are unable to tolerate supplemental phosphate.

Ages Eligible for Study
-----------------
Minimum Age: 13 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients with hereditary hypophosphatemic rickets with HHRH<br>Hereditary hypophosphatemic rickets with hypercalciuria (HHRH) | Drug: phosphate<br>* The target daily phosphate (Pi) intake is 3,500 mg/day (dietary intake plus our supplementation) for this study. Subjects will take a supplement of Pi (as KPhos Neutral 250 mg/tablet) to reach this target. Subjects will receive treatment for 30 days.<br>|
| Active Comparator: Patients with X-linked Hypophosphatemia<br>Patients with X-linked hypophosphatemia | Drug: phosphate<br>* The target daily phosphate (Pi) intake is 3,500 mg/day (dietary intake plus our supplementation) for this study. Subjects will take a supplement of Pi (as KPhos Neutral 250 mg/tablet) to reach this target. Subjects will receive treatment for 30 days.<br>|
| Active Comparator: 15 Patients with X-linked Hypophosphatemia<br>15 Patients with X-linked Hypophosphatemia that will receive phosphate treatment for 30 days. | Drug: phosphate<br>* The target daily phosphate (Pi) intake is 3,500 mg/day (dietary intake plus our supplementation) for this study. Subjects will take a supplement of Pi (as KPhos Neutral 250 mg/tablet) to reach this target. Subjects will receive treatment for 30 days.<br>|
| Active Comparator: 15 Patients Hereditary hypophosphatemic rickets with HHRH<br>15 patients withHereditary hypophosphatemic rickets with hypercalciuria (HHRH) that will receive phosphate treatment for 30 days. | Drug: phosphate<br>* The target daily phosphate (Pi) intake is 3,500 mg/day (dietary intake plus our supplementation) for this study. Subjects will take a supplement of Pi (as KPhos Neutral 250 mg/tablet) to reach this target. Subjects will receive treatment for 30 days.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Parathyroid Hormone (PTH) levels | PTH levels are expected to increase over baseline after phosphate supplement (Pi). | 30 days | 
| Fibroblast Growth Factor 23 (FGF23) levels | FGF23 levels are expected to increase over baseline after phosphate supplement (Pi). | 30 days |