FGF-23 Associates with Death, Cardiovascular Events, and Initiation of Chronic Dialysis

• Published in: Journal of the American Society of Nephrology Vol. 22; no. 10; pp. 1913 - 1922
• Main Authors: KENDRICK, Jessica, CHEUNG, Alfred K, KAUFMAN, James S, GREENE, Tom, ROBERTS, William L, SMITS, Gerard, CHONCHOL, Michel
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society of Nephrology 01.10.2011
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - blood; Cardiovascular Diseases - blood; Cardiovascular Diseases - complications; Clinical Epidemiology; Female; Fibroblast Growth Factors - blood; Humans; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - mortality; Longitudinal Studies; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Randomized Controlled Trials as Topic; Renal Dialysis; United States - epidemiology; United States; Chronic; Nephrology; Fibroblast growth factor 23; Mortality; Death; Cardiovascular disease; Dialysis; Initiation; Urology
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/ASN.2010121224

Concentrations of the phosphate-regulating hormone fibroblast growth factor-23 (FGF-23) are elevated in patients with chronic kidney disease (CKD), but whether higher plasma FGF-23 concentrations associate with all-cause mortality, cardiovascular events, or initiation of chronic dialysis is not completely understood. Here, we measured FGF-23 concentration in stored plasma samples from 1099 patients with advanced CKD who participated in The Homocysteine in Kidney and End Stage Renal Disease study. Mean serum phosphorus concentration was 4.3 mg/dl, median FGF-23 concentration was 392 RU/ml, and mean GFR was 18 ml/min/1.73 m(2). During a median follow-up of 2.9 yr, 453 (41%) patients died from any cause, 215 (20%) had a cardiovascular event, and 615 (56%) initiated chronic dialysis. Compared with the lowest quartile of FGF-23, each subsequent quartile associated with a progressively higher risk for death, adjusted for confounders (HR [95% CI] of 1.24 [0.91 to 1.69], 1.76 [1.28 to 2.44], and 2.17 [1.56 to 3.08] for the second through fourth quartiles, respectively). In addition, compared with the lowest quartile, the two highest quartiles of FGF-23 also associated with a significantly elevated risk for cardiovascular events and initiation of chronic dialysis. In conclusion, in advanced CKD, FGF-23 strongly and independently associates with all-cause mortality, cardiovascular events, and initiation of chronic dialysis.