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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Fibroblast Growth Factor-23 and Carotid Artery Intima Media Thickness in Chronic Kidney Disease
Insights
Fibroblast growth factor 23 (FGF-23) levels are significantly higher in patients with chronic kidney disease (CKD) and correlate with atherosclerosis. Monitoring FGF-23 may serve as a non-invasive marker for subclinical atherosclerosis in CKD patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biochemistry
Background:
- The pathogenesis of accelerated atherosclerosis in Chronic Kidney Disease (CKD) remains incompletely understood.
- Elevated Fibroblast Growth Factor 23 (FGF-23) levels are implicated in endothelial dysfunction and cardiovascular events, suggesting a role in CKD-related atherosclerosis.
- Limited research exists on FGF-23's role in CKD progression and atherosclerosis, particularly outside of end-stage renal disease (ESRD) dialysis patients.
Purpose of the Study:
- To investigate the association between FGF-23 levels and atherosclerosis in non-dialysis CKD patients.
- To determine if FGF-23 is an independent predictor of carotid artery intima-media thickness (IMT) in CKD stages 3-4.
- To explore FGF-23's potential as a non-invasive biomarker for subclinical atherosclerosis in CKD.
Main Methods:
- Carotid artery intima-media thickness (IMT) was measured ultrasonically in 91 CKD patients (stages 3-4) and 36 healthy controls.
- Patients and controls were matched for age, gender, BMI, and lipid profiles.
- Multivariate regression analysis was used to identify independent predictors of IMT, including FGF-23 and high-sensitivity C-reactive protein (hsCRP).
Main Results:
- CKD patients exhibited significantly higher IMT (p < 0.00001) and FGF-23 levels (p = 0.00012) compared to controls.
- Subclinical atherosclerosis (IMT > 0.750 mm) was present in 54% of CKD patients.
- Age, hsCRP, and FGF-23 levels were identified as independent predictors of IMT (p < 0.00001). Each 1 μmol/L increase in FGF-23 correlated with a 0.444 mm increase in IMT.
Conclusions:
- Serum FGF-23 levels are significantly elevated in CKD patients compared to healthy individuals.
- FGF-23 is an independent predictor of subclinical atherosclerosis in CKD patients, even after accounting for other risk factors.
- Monitoring serum FGF-23 may offer a valuable non-invasive method for assessing atherosclerosis risk in CKD.
Background:
The cause of early-accelerated atherosclerosis development observed in Chronic Kidney Disease (CKD) is not fully understood. The determination of the relationship between the levels of fibroblast growth factor 23 (FGF-23) and the development of endothelial dysfunction, left ventricular hypertrophy, and myocardial infarction lends support to the possibility that FGF-23 plays a role in the development of atherosclerosis in CKD. Only a few studies, however, have been conducted that analyze the relationship between FGF-23 levels in the progression of CKD and the development of atherosclerosis, and these studies have generally been limited to those patients receiving dialysis therapy due to end stage renal disease (ESRD).
Methods:
In the present study, carotid artery intima-media thicknesses (IMT) were measured ultrasonically as a marker of atherosclerosis in 91 patients with CKD stage 3 - 4 (61 female and 30 male, age between 19 - 65 years, glomerular filtration rate [GFR] 15 - 60 mL/min 1.73 m2, CKD was not related to diabetes mellitus, and without cardiovascular-cerebral disease) in contrast to 36 healthy volunteers (26 female and 10 male, age between 19 - 65 years, GFR > 90 mL/min 1.73 m2, and without any diagnoses of acute or chronic disease), and a possible role of FGF-23 on atherosclerosis was analyzed.
Results:
Patients were similar to controls with respect to age, gender, smoking status, body mass index, and plasma glucose and lipid profile. On the other hand, IMT measurements (p < 0.00001) and FGF-23 levels (p = 0.00012) were significantly higher in patients than controls. IMT was measured above the subclinical atherosclerosis limit of 0.750 mm in 54% of the patients. Multivariate regression analysis showed that patients' age, high sensitive c-reactive protein (hsCRP), and FGF-23 levels were independent predictors of IMT (p < 0.00001, r = 0.559). Independent of other variables, every 1 μmol/L increase in FGF-23 levels resulted in 0.444 mm increase of IMT measurements in patients with CKD.
Conclusions:
Our findings suggest that monitoring serum FGF-23 may be useful as a non-invasive indicator of subclinical atherosclerosis in patients with chronic kidney disease.
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