Tamara Isakova, MD, MMSC. At the University of Miami Miller School of Medicine and colleagues examined the relationship between the increase of FGF-23 levels and the risk of death and end-stage renal disease, chronic kidney disease stages 2 to 3879 people 4. Participants were recruited in the cohort with chronic renal failure between June 2003 and September 2008.Patients in the early stages of chronic kidney disease who had high levels of growth hormone fibroblast endocrine factors 23 (which regulates the metabolism of phosphorus) were associated with an increased risk of end-stage renal disease and death, according to a study on the June 15 issue of JAMA.
They add that the mechanisms underlying the association between high levels of FGF-23 and mortality are not clear.
The researchers note that the FGF-23 was unexpectedly more strongly associated with mortality and cardiovascular disease, chronic kidney traditional risk factors specific to certain diseases, in particular, the reduction in estimated GFR and proteinuria (protein in the excess). ‘These data underscore the potential of FGF-23 as a new risk factor for mortality in chronic kidney disease.’
Reduced estimated glomerular filtration rate was the best predictor of end-stage renal disease in the analysis of fully adjusted, and the estimated GFR changed the relationship between FGF-23 and the risk of end-stage renal disease. ‘Although the median FGF-23 was higher in more advanced chronic kidney disease, high levels of FGF-23 were independently associated with an increased risk of end-stage renal disease among participants with baseline GFR estimated at between 30 and 45 mL/min/1.73 m 2 and 45 mL/min/1.73 m2 or more but not in those with estimated GFR 30 mL/min/1.73 m2 lower. However, the risk of death according to the FGF-23 was consistent differences significant differences between the categories of estimated GFR, ‘the authors write.
To enter the study, the mean estimated glomerular filtration rate (GFR; measure of the ability of the kidneys to filter and eliminate waste) was 42.8 mL/min/1.73 m2. For a median (midpoint) follow-up of 3.5 years, 266 participants died and 410 have reached end-stage renal disease. The researchers found that the median levels of FGF-23 were significantly higher among those who have died or reached end-stage renal disease than those who remained event-free. Participants in the highest compared to lowest quartile showed a 4.3 – fold increased risk of death, the intermediate quartiles showed intermediate risk, ‘write the researchers fully adjusted models, increasing the degree. Risk of death persists throughout the range of levels of FGF-23.