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Longitudinal change in c-terminal fibroblast growth factor 23 and outcomes in patients with advanced chronic kidney

Helen V Alderson1,2, Rajkumar Chinnadurai3, Sara T Ibrahim3,4

  • 1Vascular Research Group, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK. Helen.alderson@srft.nhs.uk.

BMC Nephrology
|October 3, 2021
PubMed

Insights

Elevated Fibroblast Growth Factor 23 (FGF23) in chronic kidney disease (CKD) predicts worse outcomes. Increasing FGF23 levels over time are linked to a higher risk of death and need for Renal Replacement Therapy (RRT) in CKD patients.

Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiovascular Medicine

Background:

  • Fibroblast Growth Factor 23 (FGF23) is elevated in Chronic Kidney Disease (CKD).
  • High FGF23 is associated with adverse outcomes including death, cardiovascular events, and progression to Renal Replacement Therapy (RRT).
  • Previous studies have conflicting results regarding the impact of changing FGF23 levels over time.

Purpose of the Study:

  • To investigate the association between longitudinal changes in C-terminal FGF23 (cFGF23) and clinical outcomes in CKD patients.
  • To determine the independent contribution of time-varying cFGF23 to mortality, cardiovascular events, and RRT progression.
  • To address limitations in prior research by accounting for the dynamic nature of FGF23 levels.

Main Methods:

  • Survival analysis of 388 CKD stages 3-5 patients with serial cFGF23 measurements (mean 4.2 samples/individual).
  • Linear regression used to determine the annual rate of cFGF23 change.
  • Cox-regression analysis assessed the relationship between time-varying cFGF23 and adverse outcomes.

Main Results:

  • Median baseline eGFR was 32.3 mL/min/1.73m²; median baseline cFGF23 was 162 RU/mL.
  • Over a median follow-up of 70 months, 19.6% progressed to RRT, 22.2% died, and 13.4% experienced major non-fatal CV events.
  • Multivariate analysis revealed longitudinal cFGF23 increase was significantly associated with increased risk of death and RRT, but not cardiovascular events.

Conclusions:

  • Increasing cFGF23 levels over time are a significant predictor of mortality in CKD patients.
  • Elevated and rising cFGF23 is associated with an increased risk of progression to Renal Replacement Therapy.
  • The study highlights the prognostic value of monitoring FGF23 dynamics in CKD management.
Abstract

Keywords:
CKDSurvival outcomescFGF23

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