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Fibroblast growth factor 23, high-sensitivity cardiac troponin, and left ventricular hypertrophy in CKD

Kelsey Smith1, Christopher deFilippi, Tamara Isakova

  • 1Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|August 14, 2012
PubMed

Insights

Elevated fibroblast growth factor 23 (FGF-23) is linked to higher cardiac troponin levels in chronic kidney disease (CKD) patients. Left ventricular hypertrophy may explain this association, indicating potential cardiovascular risk in CKD.

Area of Science:

  • Nephrology
  • Cardiology
  • Biochemistry

Background:

  • Detectable cardiac troponin levels are common in chronic kidney disease (CKD) patients, even without symptomatic cardiovascular disease.
  • Abnormal troponin values correlate with coronary artery disease, left ventricular hypertrophy (LVH), and poor outcomes.
  • Elevated fibroblast growth factor 23 (FGF-23) is implicated in CKD-related LVH.

Purpose of the Study:

  • To investigate the association between FGF-23 and high-sensitivity cardiac troponin I (hs-cTnI) and troponin T (hs-cTnT) levels in CKD patients.
  • To examine the role of LVH and coronary artery calcification (CAC) as mediators in the FGF-23 and hs-cTnI/T relationship.

Main Methods:

  • Cross-sectional observational study of 153 stable, non-dialysis-dependent CKD outpatients.
  • Measured FGF-23, hs-cTnI, hs-cTnT, left ventricular mass index (LVMI) via echocardiography, and CAC via computed tomography.
  • Analyzed associations and evaluated LVMI and CAC as potential mediators.

Main Results:

  • Patients had a mean age of 64 years and eGFR of 34 mL/min/1.73 m(2).
  • Median FGF-23, hs-cTnI, and hs-cTnT levels were 120 RU/mL, 6.5 pg/mL, and 16.8 pg/mL, respectively.
  • Significant associations were found between FGF-23 and hs-cTnI/T levels. Adjusting for LVMI attenuated this association, while adjusting for CAC did not.

Conclusions:

  • Minimally elevated hs-cTnI and hs-cTnT levels are associated with elevated FGF-23 in stable CKD outpatients.
  • FGF-23-associated LVH may contribute to detectable troponin levels in non-dialysis-dependent CKD.
  • Further research is needed, as vitamin D levels were not measured and coronary artery disease prevalence might be underestimated.
Abstract

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