FGF-23: the rise of a novel cardiovascular risk marker in CKD

Nephrol Dial Transplant. 2012 Aug;27(8):3072-81. doi: 10.1093/ndt/gfs259.


Elevated plasma levels of the phosphaturic hormone fibroblast growth factor 23 (FGF-23) are a hallmark of chronic kidney disease (CKD)-mineral and bone disorder. FGF-23 allows serum phosphate levels within physiological limits to be maintained in progressive CKD until end-stage renal disease is reached. Despite its seemingly beneficial role in phosphate homeostasis, several prospective studies in dialysis patients and in patients with less advanced CKD associated elevated FGF-23 with poor cardiovascular and renal outcome. Moreover, very recent evidence suggests an adverse prognostic impact of elevated FGF-23 even in subjects without manifest CKD. These epidemiological data are supplemented by laboratory findings that reveal a pathophysiological role of FGF-23 in the pathogenesis of myocardial injury. In aggregate, these clinical and experimental data identify FGF-23 as a promising target of novel therapeutic interventions in CKD and beyond, which should be tested in future clinical trials.

Publication types

  • Review

MeSH terms

  • Biomarkers / metabolism
  • Calcium / metabolism
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / metabolism*
  • Disease Progression
  • Fibroblast Growth Factors / metabolism*
  • Humans
  • Models, Biological
  • Phosphates / metabolism
  • Phosphorus Metabolism Disorders / etiology
  • Phosphorus Metabolism Disorders / metabolism
  • Prognosis
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / metabolism*
  • Risk Factors


  • Biomarkers
  • Phosphates
  • Fibroblast Growth Factors
  • fibroblast growth factor 23
  • Calcium