Elevated FGF-23 Bad for CKD Patients

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Elevated plasma levels of fibroblast growth factor 23 (FGF-23) predict an increased risk of cardiovascular events and death in non-dialysis CKD patients, according to researchers.

Sarah Seiler, MD, and colleagues at the University of Saarland, Homburg, Germany, measured plasma FGF-23 levels in 149 CKD patients not undergoing dialysis treatment.

They stratified patients according to FGF-23 levels (greater than 104 rU/mL  vs. 104 rU/mL or less ) and followed patients until death or until July 31, 2009. At baseline, the patients with normal and elevated FGF-23 levels were similar with respect to traditional cardiovascular risk factors and prevalence of cardiovascular disease.

During a mean follow-up period of 4.8 years, 50 patients (34%) experienced a cardiovascular event. Compared with subjects with lower FGF-23 levels, those with elevated levels had worse event-free survival.

After adjusting for numerous potential confounders, elevated FGF-23 levels were associated with a 2.5 times increased risk of cardiovascular events or death, Dr. Seiler's group reported in Nephrology Dialysis Transplantation (published online ahead of print). Each 1-log increment in FGF-23 was associated with a 60% increased risk.

The study is the first to demonstrate the association between FGF-23 levels and future cardiovascular events in non-dialysis CKD patients, Dr. Seiler's group stated. Other studies have demonstrated that elevated FGF-23 levels predict mortality in hemodialysis patients.

A protein synthesized and secreted by osteoblasts and osteocytes, FGF-23 is a potent regulator of serum phosphate, the authors explained.

The researchers observed that lowering FGF-23 levels, such as by oral phosphate binder use, “could emerge as a promising new therapeutic option to reduce cardiovascular morbidity in CKD patients.”

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