Fibroblast growth factor 23 predicts incident diabetic kidney disease: A 4.6-year prospective study

Fibroblast growth factor (FGF) 23 is a bone-derived phosphaturic hormone that participates in the regulation of mineral metabolism and the development of chronic kidney disease. This study aimed to investigate the association between FGF23 and diabetic kidney disease (DKD) in a community-based prospective cohort.

Of 7230 individuals who completed a 4.6-year follow-up survey, 1614 individuals with diabetes at baseline were included in this study. Baseline serum FGF23 levels were measured by enzyme-linked immunosorbent assay. Multiple and ordinal logistic regression analyses were used to examine the predictive performance of baseline FGF23 for incident DKD.

Baseline serum FGF23 levels exhibited an earlier elevation in the course of DKD and a gradual increase with the progressive stages of DKD (p < 0.05), while no statistical changes were observed in serum calcium and phosphorus levels. Over a 4.6-year follow-up, 198 individuals with diabetes developed incident DKD. Baseline FGF23 was significantly associated with the incidence of DKD (odds ratio 1.290 [95% CI 1.063, 1.565]) after adjusting for conventional DKD risk factors, especially in individuals with lower body mass index (<24 kg/m²), worse glycaemic control (HbA1c ≥7%), and shorter duration of diabetes (<5 years). Moreover, FGF23 models exhibited great performances in DKD risk prediction and yielded increments compared to traditional DKD risk factors (p < 0.05).

Serum FGF23 level increased at early stages of DKD, and it was an independent predictor of incident DKD, suggesting its potential for early identification of individuals at risk.