FGF-23 as a Predictor of Renal Outcome in Diabetic Nephropathy
- 1 February 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 6 (2), 241-247
- https://doi.org/10.2215/cjn.04250510
Abstract
Background and objectives Fibroblast growth factor 23 (FGF-23) has emerged as a new factor in mineral metabolism in chronic kidney disease (CKD). An important regulator of phosphorus homeostasis, FGF-23 has been shown to independently predict CKD progression in nondiabetic renal disease. We analyzed the relation between FGF-23 and renal outcome in diabetic nephropathy (DN). Design, setting, participants, & measurements DN patients participating in a clinical trial (enalapril+placebo versus enalapril+losartan) had baseline data collected and were followed until June 2009 or until the primary outcome was reached. Four patients were lost to follow-up. The composite primary outcome was defined as death, doubling of serum creatinine, and/or dialysis need. Results At baseline, serum FGF-23 showed a significant association with serum creatinine, intact parathyroid hormone, proteinuria, urinary fractional excretion of phosphate, male sex, and race. Interestingly, FGF-23 was not related to calcium, phosphorus, 25OH-vitamin D, or 24-hour urinary phosphorus. Mean follow-up time was 30.7 ± 10 months. Cox regression showed that FGF-23 was an independent predictor of the primary outcome, even after adjustment for creatinine clearance and intact parathyroid hormone (10 pg/ml FGF-23 increase = hazard ratio, 1.09; 95% CI, 1.01 to 1.16, P = 0.02). Finally, Kaplan-Meier analysis showed a significantly higher risk of the primary outcome in patients with FGF-23 values of >70 pg/ml. Conclusions FGF-23 is a significant independent predictor of renal outcome in patients with macroalbuminuric DN. Further studies should clarify whether this relation is causal and whether FGF-23 should be a new therapeutic target for CKD prevention.This publication has 28 references indexed in Scilit:
- Dietary and genetic evidence for phosphate toxicity accelerating mammalian agingThe FASEB Journal, 2010
- Association of Serum Phosphate with Vascular and Valvular Calcification in Moderate CKDJournal of the American Society of Nephrology, 2009
- Serum Phosphorus Levels Associate with Coronary Atherosclerosis in Young AdultsJournal of the American Society of Nephrology, 2009
- Variability and Risk Factors for Kidney Disease Progression and Death Following Attainment of Stage 4 CKD in a Referred CohortAmerican Journal of Kidney Diseases, 2008
- Plasma levels of fibroblast growth factor-23 and mineral metabolism in diabetic and non-diabetic patients on chronic hemodialysisInternational Urology and Nephrology, 2008
- Fibroblast Growth Factor 23 and Mortality among Patients Undergoing HemodialysisNew England Journal of Medicine, 2008
- Paricalcitol Reduces Albuminuria and Inflammation in Chronic Kidney DiseaseHypertension, 2008
- Relations of Serum Phosphorus and Calcium Levels to the Incidence of Cardiovascular Disease in the CommunityArchives of Internal Medicine, 2007
- Severely Reduced Production of Klotho in Human Chronic Renal Failure KidneyBiochemical and Biophysical Research Communications, 2001
- Coronary-Artery Calcification in Young Adults with End-Stage Renal Disease Who Are Undergoing DialysisNew England Journal of Medicine, 2000