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

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

Joachim H Ix  1 , Michael G Shlipak, Christina L Wassel, Mary A Whooley
Affiliations

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

Joachim H Ix et al. Nephrol Dial Transplant. 2010 Mar.

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.

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Figures

Fig. 1
Fig. 1
Cubic spline function demonstrating that the adjusted association of (A) eGFRCr, (B) eGFRCys and (C) ACR with plasma FGF-23 levels. Solid lines represent the adjusted point estimates, and dotted lines represent the 95% confidence intervals. The y-axis demonstrates the beta coefficient, representing the change in natural log transformed FGF-23 levels per unit change in kidney function. *The spline functions for eGFRCr and eGFRCys was adjusted for age, sex, race, ACR, systolic blood pressure, diastolic blood pressure, diabetes and body mass index. Spline function for ACR was adjusted for age, sex, race, eGFRCys, systolic blood pressure, diastolic blood pressure, diabetes and body mass index.
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