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Fibroblast growth factor 23 and left ventricular hypertrophy in children on dialysis
Wacharee Seeherunvong1, Carolyn L Abitbol1, Jayanthi Chandar1
1Division of Pediatric Nephrology, University of Miami Miller School of Medicine and Holtz Children's Hospital/Jackson Memorial Medical Center, PO Box 016960 (M-714), Miami, FL, 33101, USA.
Insights
Elevated fibroblast growth factor 23 (FGF-23) is linked to left ventricular hypertrophy (LVH) in pediatric hemodialysis patients. Higher FGF-23 levels correlate with increased LVMI, suggesting FGF-23’s role in cardiac hypertrophy.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Endocrinology
Background:
- Elevated fibroblast growth factor 23 (FGF-23) is associated with left ventricular hypertrophy (LVH) in adults with chronic kidney disease.
- The relationship between FGF-23 and cardiac structure in pediatric hemodialysis patients is not well-established.
Purpose of the Study:
- To investigate the association between FGF-23 levels and left ventricular mass index (LVMI) and LVH in pediatric patients undergoing maintenance hemodialysis.
- To test the hypothesis that FGF-23 is linked to cardiac hypertrophy in this population.
Main Methods:
- Retrospective study of 26 pediatric patients (aged 6-21 years) on chronic hemodialysis.
- Echocardiography was used to assess cardiac structure and geometry.
- Circulating levels of FGF-23 and calciotropic hormones were measured.
Main Results:
- FGF-23 levels were significantly elevated in all patients.
- 55% of patients exhibited LVH, with an average LVMI of 43 ± 13 g/m(2.7).
- Log-transformed FGF-23 concentrations correlated with LVMI (p=0.03) and were independently associated with interventricular septal thickness Z-score (p<0.001). Each 1 SD increase in log-FGF-23 was linked to a 17% increase in LVMI.
Conclusions:
- FGF-23 levels are strongly associated with increased LVMI and prevalent LVH in pediatric hemodialysis patients.
- These findings support the hypothesis linking FGF-23 to cardiac hypertrophy in pediatric chronic kidney disease patients.
Background:
Elevated fibroblast growth factor 23 (FGF-23) concentrations associate with left ventricular hypertrophy (LVH) and adverse outcomes in adult patients with chronic kidney disease. We hypothesized that similar associations are present in pediatric patients on maintenance hemodialysis.
Methods:
In this retrospective study of 26 young patients on chronic hemodialysis, aged 6-21 years, cardiac structure and geometry were measured by echocardiography, and circulating levels of FGF-23 and calciotropic hormones were obtained.
Results:
FGF-23 levels were uniformly elevated in all patients from three- to 835-fold above the upper limit of normal. The average LV mass index (LVMI) was 43 ± 13 g/m(2.7) and reflected LVH in 55 % of patients. Log-transformed FGF-23 concentrations correlated with LVMI (p = 0.03) and were independently associated with the interventricular septal thickness Z-score (p < 0.001). Concentric LVH was associated with the highest FGF-23 concentrations and the highest LVMI measurements (p < 0.001). Each 1 standard deviation increase in log-transformed FGF-23 levels was associated with a 17 % increase in LVMI.
Conclusions:
FGF-23 levels are strongly associated with increased LVMI and with prevalent LVH in pediatric hemodialysis patients. Our cross-sectional findings provide observational evidence supporting the hypothesis linking FGF-23 to cardiac hypertrophy in patients with chronic kidney disease.
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