Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 May;22(5):956-66.
doi: 10.1681/ASN.2010080894. Epub 2011 Mar 24.

Elevated fibroblast growth factor 23 is a risk factor for kidney transplant loss and mortality

Myles Wolf  1 , Miklos Z Molnar, Ansel P Amaral, Maria E Czira, Anna Rudas, Akos Ujszaszi, Istvan Kiss, Laszlo Rosivall, Janos Kosa, Peter Lakatos, Csaba P Kovesdy, Istvan Mucsi
Affiliations

Elevated fibroblast growth factor 23 is a risk factor for kidney transplant loss and mortality

Myles Wolf et al. J Am Soc Nephrol. 2011 May.

Abstract

An increased circulating level of fibroblast growth factor 23 (FGF23) is an independent risk factor for mortality, cardiovascular disease, and progression of chronic kidney disease (CKD), but its role in transplant allograft and patient survival is unknown. We tested the hypothesis that increased FGF23 is an independent risk factor for all-cause mortality and allograft loss in a prospective cohort of 984 stable kidney transplant recipients. At enrollment, estimated GFR (eGFR) was 51 ± 21 ml/min per 1.73 m(2) and median C-terminal FGF23 was 28 RU/ml (interquartile range, 20 to 43 RU/ml). Higher FGF23 levels independently associated with increased risk of the composite outcome of all-cause mortality and allograft loss (full model hazard ratio: 1.46 per SD increase in logFGF23, 95% confidence interval: 1.28 to 1.68, P<0.001). The results were similar for each component of the composite outcome and in all sensitivity analyses, including prespecified analyses of patients with baseline eGFR of 30 to 90 ml/min per 1.73 m(2). In contrast, other measures of phosphorus metabolism, including serum phosphate and parathyroid hormone (PTH) levels, did not consistently associate with outcomes. We conclude that a high (or elevated) FGF23 is an independent risk factor for death and allograft loss in kidney transplant recipients.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Higher FGF23 levels associate with greater incidence of mortality and allograft loss in kidney transplant recipients. Cumulative incidence plots of FGF23 tertiles and the composite outcome of all-cause mortality and allograft loss (A), all-cause mortality alone (B), and allograft loss alone (C). For each analysis, the P for trend was <0.0001.
Figure 2.
Figure 2.
Ascending tertiles of FGF23 but not PTH, phosphate, or hemoglobin independently associate with greater risk of the composite outcome of all-cause mortality and allograft loss. Hazard ratios for the composite outcome of all-cause mortality and allograft loss according to tertiles of FGF23, PTH, phosphate, and hemoglobin derived from the respective full multivariable models. For each exposure, the lowest tertile served as the referent group (REF). Ascending tertiles of FGF23 were independently associated with increased risk of the composite outcome (P < 0.001), but the relationships between the other analytes and outcomes were all nonsignificant (NS).
See this image and copyright information in PMC

Comment in

References

    1. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK: Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341: 1725–1730, 1999 - PubMed
    1. Pascual M, Theruvath T, Kawai T, Tolkoff-Rubin N, Cosimi AB: Strategies to improve long-term outcomes after renal transplantation. N Engl J Med 346: 580–590, 2002 - PubMed
    1. Howard RJ, Patton PR, Reed AI, Hemming AW, Van der Werf WJ, Pfaff WW, Srinivas TR, Scornik JC: The changing causes of graft loss and death after kidney transplantation. Transplantation 73: 1923–1928, 2002 - PubMed
    1. Gutierrez OM, Mannstadt M, Isakova T, Rauh-Hain JA, Tamez H, Shah A, Smith K, Lee H, Thadhani R, Juppner H, Wolf M: Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359: 584–592, 2008 - PMC - PubMed
    1. Gutierrez OM, Januzzi JL, Isakova T, Laliberte K, Smith K, Collerone G, Sarwar A, Hoffmann U, Coglianese E, Christenson R, Wang TJ, deFilippi C, Wolf M: Fibroblast growth factor 23 and left ventricular hypertrophy in chronic kidney disease. Circulation 119: 2545–2552, 2009 - PMC - PubMed

Publication types