Fibroblast growth factor 23: a possible cause of left ventricular hypertrophy in hemodialysis patients

Am J Med Sci. 2009 Feb;337(2):116-22. doi: 10.1097/MAJ.0b013e3181815498.


Background: Left ventricular hypertrophy (LVH) is a common cardiovascular disorder and an independent risk factor for cardiovascular death in dialysis patients. Hyperphosphatemia is associated with LVH. Previous studies have shown that fibroblast growth factor 23 (FGF23), which has an important role in phosphate metabolism, is elevated in chronic hemodialysis patients.

Objectives: The aim of this study is to determine the association of FGF23 and LVH and the prognostic value of FGF23 in chronic hemodialysis patients.

Materials and methods: One hundred twenty-four end-stage renal disease patients were evaluated for LVH by echocardiography. Serum FGF23 levels were measured using a commercial enzyme-linked immunosorbent assay kit.

Results: Patients with LVH were more likely to have poor urea clearance (Kt/V), higher systolic blood pressure, and comorbidity of diabetes mellitus and coronary artery disease. LVH was also associated with higher levels of FGF23. Multivariate analysis indicated that FGF23 level, systolic blood pressure, and comorbidity of diabetes mellitus and coronary artery disease remained correlated with LVH. This suggested that serum FGF23 level is independently associated with LVH in our hemodialysis patients. Cox analysis indicated no significant difference in risk of death for patients with elevated levels of FGF23.

Conclusion: LVH has a high prevalence in hemodialysis patients, and FGF23 is independently associated with LVH but is not a predictor for short-term prognosis (2-year follow-up).

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Echocardiography
  • Female
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / blood*
  • Humans
  • Hypertrophy, Left Ventricular / blood*
  • Hypertrophy, Left Ventricular / diagnostic imaging
  • Hypertrophy, Left Ventricular / etiology*
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Renal Dialysis / adverse effects*
  • Risk Factors
  • Young Adult


  • FGF23 protein, human
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23