Fibroblast growth factor-23 and early decrements in kidney function: the Heart and Soul Study

Nephrol Dial Transplant. 2010 Mar;25(3):993-7. doi: 10.1093/ndt/gfp699. Epub 2009 Dec 27.

Abstract

Background: Fibroblast growth factor-23 (FGF-23) is associated with mortality in dialysis patients, and concentrations are elevated in moderate chronic kidney disease (CKD). The threshold of CKD or albuminuria at which FGF-23 begins to change is unknown.

Methods: In 792 outpatients with stable cardiovascular disease (CVD) and normal kidney function to moderate CKD, we evaluate the associations of estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) with plasma FGF-23 concentrations.

Results: Compared to participants with eGFR >or=90 ml/min/1.73 m(2), mean FGF-23 concentrations were 7.8 RU/ml higher (4.3-11.5, P = 0.01) in those with eGFR 60-89 ml/min/1.73 m(2) in models adjusted for age, sex, race, ACR, blood pressure, diabetes and body mass index. More advanced decrements in eGFR were associated with much higher FGF-23 concentrations. In spline analysis, the slope of change in FGF-23 concentration was evident at eGFR <90 ml/min/1.73 m(2). Compared to participants with ACR <30 mg/g, mean FGF-23 concentrations were 18.4 RU/ml higher (9.3-29.2, P < 0.001) in those with ACR 30-299 mg/g in models adjusted for identical covariates plus eGFR and much higher in individuals with ACR >or=300 mg/g. Spline analysis demonstrated a linear relationship of ACR with FGF-23, independent of eGFR, even among persons with ACR <30 mg/g.

Conclusion: Modest decrements in eGFR or elevations in albuminuria are each independently associated with higher FGF-23 concentrations in outpatients with stable CVD.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Albuminuria / blood
  • Albuminuria / physiopathology
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / physiopathology
  • Chronic Disease
  • Creatinine / urine
  • Cross-Sectional Studies
  • Female
  • Fibroblast Growth Factors / blood*
  • Glomerular Filtration Rate / physiology*
  • Humans
  • Kidney / physiopathology*
  • Kidney Diseases / blood
  • Kidney Diseases / physiopathology*
  • Male
  • Middle Aged

Substances

  • Fibroblast Growth Factors
  • fibroblast growth factor 23
  • Creatinine