Fibroblast Growth Factor 23, High-Sensitivity Cardiac Troponin, and Left Ventricular Hypertrophy in CKD

• Published in: American journal of kidney diseases Vol. 61; no. 1; pp. 67 - 73
• Main Authors: Smith, Kelsey, BA, deFilippi, Christopher, MD, Isakova, Tamara, MD, MMSc, Gutiérrez, Orlando M., MD, MMSc, Laliberte, Karen, MS, RN, Seliger, Stephen, MD, Kelley, Walter, DO, Duh, Show-Hong, PhD, Hise, Michael, MD, Christenson, Robert, PhD, Wolf, Myles, MD, MMSc, Januzzi, James, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.01.2013; Elsevier
• Subjects: Aged; Biological and medical sciences; Biomarkers - blood; chronic kidney disease; Comorbidity; Coronary Artery Disease - epidemiology; Cross-Sectional Studies; Echocardiography; Female; Fibroblast growth factor 23; Fibroblast Growth Factors - blood; Glomerular Filtration Rate - physiology; high-sensitivity cardiac troponin; Humans; Hypertrophy, Left Ventricular - blood; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - epidemiology; Kidneys; left ventricular hypertrophy; Male; Medical sciences; Middle Aged; Multivariate Analysis; Nephrology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prevalence; Prognosis; Renal failure; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Sensitivity and Specificity; Troponin I - blood; Urinary system involvement in other diseases. Miscellaneous; chronic kidney disease; Fibroblast growth factor 23; left ventricular hypertrophy; high-sensitivity cardiac troponin; Kidney disease; Heart; Nephrology; Urinary system disease; Chronic kidney disease; Urology; Left ventricle; Troponin; High sensitivity; Renal failure; Circulatory system; Hypertrophy
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2012.06.022

Background Detectable levels of cardiac troponins are common in individuals with chronic kidney disease (CKD), even in the absence of symptomatic cardiovascular disease. Abnormal cardiac troponin values are associated with coronary artery disease and left ventricular hypertrophy (LVH) and predict poor clinical outcomes. Elevated levels of fibroblast growth factor 23 (FGF-23) contribute to LVH in CKD. We investigated the association of FGF-23 and hs-cTnI (high-sensitivity cardiac troponin I) and hs-cTnT (high-sensitivity cardiac troponin T) levels in CKD and examined the role of LVH in this association. Study Design Cross-sectional observational study. Setting & Participants 153 stable outpatients with non–dialysis-dependent CKD. Predictor The primary predictor was FGF-23 level. Outcomes hs-cTnI, hs-cTnT. Measurements FGF-23, hs-cTnI, hs-cTnT; left ventricular mass index (LVMI) assessed by echocardiography; coronary artery calcification (CAC) measured by computed tomography. LVMI and CAC were evaluated as potential mediators of the effect of FGF-23 on hs-cTnI/T. Results Mean age was 64 ± 12 (SD) years, mean estimated glomerular filtration rate was 34 ± 11 mL/min/1.73 m2 , median FGF-23 level was 120 (25th-75th percentile, 79-223) reference unit (RU)/mL, median hs-cTnI level was 6.5 (25th-75th percentile, 3.5-14.5) pg/mL, and median hs-cTnT level was 16.8 (25th-75th percentile, 11.1-33.9) pg/mL. cTnI and cTnT concentrations were higher than the 99th percentile of a healthy population in 42% and 61% of patients, respectively. In unadjusted and multivariable-adjusted analyses, hs-cTnI/T levels were associated significantly with FGF-23 levels. Adjusting for LVMI, but not CAC, weakened the association of FGF-23 and hs-cTnI/T levels. Limitations Vitamin D levels were not measured. The prevalence of coronary artery disease may have been underestimated because it was ascertained by self-report. Conclusions Minimally elevated cTnI and cTnT levels, detectable by high-sensitivity assays, are associated with elevated FGF-23 levels in stable outpatients with CKD. FGF-23–associated LVH may contribute to detectable hs-cTnI/T levels observed in non–dialysis-dependent patients with CKD.