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FGF-23 Linked to End-Stage Renal Disease and Death

Elevated fibroblast growth factor 23 predicts end stage and death in chronic kidney disease

WEDNESDAY, June 15 (HealthDay News) -- In patients with chronic kidney disease, elevated fibroblast growth factor 23 (FGF-23) is associated with end-stage renal disease and death, according to a study published in the June 15 issue of the Journal of the American Medical Association.

Tamara Isakova, M.D., from the University of Miami Miller School of Medicine, and colleagues evaluated whether FGF-23 was a risk factor for adverse outcomes in 3,879 patients with chronic kidney disease, who were enrolled in the Chronic Renal Insufficiency Cohort between 2003 and 2008. Participants had an average baseline estimated glomerular filtration rate (GFR) of 42.8 mL/min/1.73 m², and FGF-23 level of 145.5 reference units/mL. They were followed up for an average of 3.5 years, during which time, end-stage renal disease and all-cause mortality were the main outcomes studied.

The investigators identified 410 cases of end-stage renal disease (33.0/1,000 person-years) and 266 deaths (20.3/1,000 person-years) during follow-up. After adjusting for variables, higher FGF-23 levels were independently and significantly correlated with an increased risk of death (hazard ratio [HR], 1.5). The mortality risk increased from the second to the fourth quartile of FGF-23 (HR, 1.3 and 3.0, respectively). Higher FGF-23 correlated independently with a significantly increased risk of end-stage renal disease in patients with an estimated GFR between 30 and 44 mL/min/1.73 m², or 45 mL/min/1.73 m² or higher, but not when GFR was less than 30 mL/min/1.73 m².

"Elevated FGF-23 is an independent risk factor for end-stage renal disease in patients with relatively preserved kidney function and for mortality across the spectrum of chronic kidney disease," the authors write.

Two of the study authors disclosed financial relationships with the pharmaceutical industry.

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