Journal
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 29, Issue 2, Pages 579-590Publisher
AMER SOC NEPHROLOGY
DOI: 10.1681/ASN.2017070772
Keywords
-
Categories
Funding
- National Institutes of Health (NIH) [R01DK102438, R01DK110087, K23DK095949, R01DK099199, R01DK081374, R01DK076116, R01DK094796, K24DK093723, U01DK099930]
- Department of Veterans Affairs Health Services Research and Development Service grant
- American Heart Association
- National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
- Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science award NIH/National Center for Advancing Translational Sciences (NCATS) [UL1TR000003]
- Johns Hopkins University [UL1 TR-000424]
- University of Maryland General Clinical Research Center [M01 RR-16500]
- Clinical and Translational Science Collaborative of Cleveland from the NCATS component of the NIH [UL1TR000439]
- NIH roadmap for Medical Research
- Michigan Institute for Clinical and Health Research [UL1TR000433]
- University of Illinois at Chicago Clinical and Translational Science Award [UL1RR029879]
- Tulane Center of Biomedical Research Excellence for Clinical and Translational Research in Cardiometabolic Diseases [P20 GM109036]
- Kaiser Permanente NIH/National Center for Research Resources University of California San Francisco Clinical and Translational Science Institute [UL1 RR-024131]
Ask authors/readers for more resources
Elevated fibroblast growth factor 23 (FGF23) levels, measured at a single time, are strongly associated with increased risk of mortality in patients with CKD. There are minimal data on serial FGF23 measurements in CKD. In a prospective case-cohort study of the Chronic Renal Insufficiency Cohort, we measured FGF23 at two to five annual time points (mean 4.0 +/- 1.2) in a randomly selected subcohort of 1135 participants, of whom 203 died, and all remaining 390 participants who died through mid-2013. Higher FGF23 was independently associated with increased risk of death in multivariable-adjusted analyses of time-varying FGF23 (hazard ratio per 1-SD increase in ln-transformed FGF23, 1.84; 95% CI, 1.67 to 2.03). Median FGF23 was stable over 5 years of follow-up, but its gradually right-skewed distribution suggested a subpopulation with markedly elevated FGF23. Trajectory analysis revealed three distinct trajectories: stable FGF23 in the majority of participants (slope of lnFGF23 per year=0.03, 95% CI, 0.02 to 0.04, n=724) and smaller subpopulations with slowly (slope=0.14, 95% CI, 0.12 to 0.16, n=486) or rapidly (slope=0.46, 95% CI, 0.38 to 0.54, n=99) rising levels. Compared with stable FGF23, participants with slowly rising FGF23 trajectories were at 4.49-fold higher risk of death (95% CI, 3.17 to 6.35) and individuals with rapidly rising FGF23 trajectories were at 15.23-fold higher risk of death (95% CI, 8.24 to 28.14) in fully adjusted analyses. Trajectory analyses that used four or three annual FGF23 measurements yielded qualitatively similar results. In conclusion, FGF23 levels are stable over time in the majority of patients with CKD, but serial measurements identify subpopulations with rising levels and exceptionally high risk of death.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available