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Updated: Dec 6, 2025

A Simple Bioassay for the Evaluation of Vascular Endothelial Growth Factors
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Fibroblast growth factor 23 as a risk factor for cardiovascular events and mortality in patients in the EVOLVE trial

Geoffrey A Block1, Glenn M Chertow2, Kerry Cooper3

  • 1US Renal Care, Plano, Texas, USA.

Hemodialysis International. International Symposium on Home Hemodialysis
|October 5, 2020
PubMed

Insights

High fibroblast growth factor 23 (FGF23) levels are linked to increased cardiovascular event risk in patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) on dialysis. FGF23 may serve as a key biomarker and therapeutic target.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • High mortality in chronic kidney disease-mineral and bone disorder (CKD-MBD) patients on maintenance hemodialysis is primarily driven by cardiovascular (CV) events.
  • Understanding the role of mineral and bone disorder parameters and fibroblast growth factor 23 (FGF23) in CV risk is crucial.

Purpose of the Study:

  • To evaluate the association between mineral and bone disorder parameters, FGF23 concentrations, and clinically adjudicated CV events in CKD-MBD patients undergoing maintenance hemodialysis.
  • To determine if FGF23 is an independent predictor of CV events in this patient population.

Main Methods:

  • Analysis of data from the Evaluation of Cinacalcet Hydrochloride Therapy to Lower Cardiovascular Events (EVOLVE) trial.
  • Inclusion of patients with evaluable baseline and week 20 values for key laboratory parameters (parathyroid hormone, calcium, phosphate, FGF23).
  • Utilized adjusted Cox proportional hazards regression models to assess the relative risk of CV events based on FGF23 and MBD parameters.

Main Results:

  • A total of 2309 patients were assessed, with 1037 CV events occurring over a mean follow-up of 3.1 years.
  • Adjusted models revealed a significant association between FGF23 levels and the risk of CV events.
  • Hazard ratios indicated that higher FGF23 levels (per log unit) were associated with increased CV event risk (HR=1.09, 95% CI: 1.03-1.16).

Conclusions:

  • Fibroblast growth factor 23 (FGF23) is identified as an independent cardiovascular risk factor in patients with CKD-MBD on maintenance hemodialysis.
  • FGF23 shows potential as a valuable biomarker for predicting CV events in this high-risk group.
  • Targeting FGF23 may offer a novel therapeutic strategy to reduce cardiovascular morbidity and mortality in CKD-MBD patients.
Abstract

Keywords:
Chronic kidney diseaseFGF23hemodialysishyperparathyroidismmineral metabolismparathyroid hormone

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