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Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Fibroblast growth factor-23 and early decrements in kidney function: the Heart and Soul Study

Joachim H Ix1, Michael G Shlipak, Christina L Wassel

  • 1Division of Nephrology, Department of Medicine, University of California San Diego, San Diego, CA, USA. joeix@ucsd.edu

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|December 29, 2009
PubMed

Insights

Fibroblast growth factor-23 (FGF-23) levels increase with declining kidney function (eGFR) and rising albuminuria (ACR) in patients with cardiovascular disease. These changes occur even with mild chronic kidney disease (CKD) or early signs of kidney damage.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Fibroblast growth factor-23 (FGF-23) is linked to mortality in dialysis patients.
  • Elevated FGF-23 is observed in moderate chronic kidney disease (CKD).
  • The specific CKD or albuminuria threshold for FGF-23 changes is unknown.

Purpose of the Study:

  • To investigate the association between estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) with plasma FGF-23 concentrations.
  • To identify the threshold of CKD or albuminuria at which FGF-23 levels begin to change.

Main Methods:

  • Study included 792 outpatients with stable cardiovascular disease (CVD) and normal to moderate CKD.
  • Evaluated associations of eGFR and ACR with plasma FGF-23 levels.
  • Statistical models adjusted for age, sex, race, ACR, blood pressure, diabetes, and body mass index.

Main Results:

  • FGF-23 was significantly higher with eGFR <90 ml/min/1.73 m(2), with a clear change slope evident below this threshold.
  • FGF-23 concentrations increased with albuminuria, with significant elevations at ACR 30-299 mg/g and higher at ACR ≥300 mg/g.
  • A linear relationship between ACR and FGF-23 was observed, independent of eGFR.

Conclusions:

  • Modest reductions in eGFR are independently associated with increased FGF-23 concentrations.
  • Mild elevations in albuminuria are independently associated with higher FGF-23 levels.
  • These findings highlight early changes in kidney function and damage markers related to FGF-23 in CVD patients.
Abstract

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