FGF23 and Cardiovascular Structure and Function in Advanced Chronic Kidney Disease.

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Fibroblast Growth Factor 23 (FGF23) is a bone-derived hormone elevated in chronic kidney disease (CKD).
• Elevated FGF23 is implicated in cardiovascular disease development in CKD patients.
• The association between FGF23 and cardiovascular functional capacity in CKD is not well understood.

Purpose of the Study:

• To investigate the association between FGF23 levels and cardiovascular functional capacity (VO2Max) in advanced CKD patients.
• To determine if FGF23 levels change after kidney transplantation and correlate with improvements in VO2Max.
• To examine the relationship between FGF23 and cardiac structure (LVMI) in CKD and post-transplantation.

Main Methods:

• Secondary analysis of 235 patients from the Cardiopulmonary Exercise Testing in Renal Failure and After Kidney Transplantation (CAPER) cohort.
• Patients included those with stage 5 CKD, kidney transplant recipients, and hypertensive controls.
• Cardiopulmonary exercise testing (CPET), echocardiography, and longitudinal follow-up for 1 year were performed.

Main Results:

• Higher FGF23 levels correlated with impaired VO2Max, increased left ventricular mass index (LVMI), reduced peak exercise heart rate, and lower maximal workload.
• Kidney transplantation led to a significant decrease in FGF23 and a subsequent improvement in VO2Max.
• Changes in FGF23 were significantly associated with VO2Max both in advanced CKD and after kidney transplantation.

Conclusions:

• FGF23 levels are associated with impaired cardiovascular functional capacity in advanced CKD and post-kidney transplantation.
• FGF23 is linked to cardiac structural changes in advanced CKD, influenced by dialysis status, but not post-transplantation.
• These findings suggest FGF23 as a potential biomarker and therapeutic target in CKD-related cardiovascular complications.