Biomarkers Predict Renal Function Decline, CV Events
High levels of parathyroid hormone and fibroblast growth factor 23 in CKD patients are associated with need for renal replacement therapy or a 50% or greater decline in eGFR.
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NEW ORLEANS—Patients with chronic kidney disease who have high levels of parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) are more likely to experience a decline in renal function. Likewise, higher FGF23 with lower 1,25-dihydroxyvitamin D (1,25(OH)2D) predicts cardiovascular (CV) events. These are the conclusions of separate new studies presented Friday at the American Society of Nephrology's Kidney Week 2017 meeting.
Adeera Levin, MD, of the University of British Columbia in Vancouver, Canada, and her team analyzed data on up to 1812 patients with chronic kidney disease (mean age 68 years; 62% male) from the prospective CanPREDDICT cohort 2008–2013. At baseline, 19%, 42%, and 39% had an estimated glomerular filtration rate (eGFR) below 20, 20 to 29, and 30 to 45 mL/min/1.73m2, respectively.
Over a median follow-up of 41 months, 24% progressed to the need for renal replacement therapy (RRT) or had 50% decline in eGFR. Higher PTH and FGF23 levels[MT1] [NP2] significantly predicted renal function decline, even after adjusting age, sex, blood pressure, weight, eGFR, albumin-to-creatinine ratio, albumin, phosphate, bicarbonate, calcium, hemoglobin, and potassium.
Lower 1,25(OH)2D levels also predicted greater likelihood of renal function decline. The researchers found the ratios of 1,25(OH)2D to PTH and to FGF23 particularly insightful.
In separate analyses, higher FGF23 levels and lower 1,25(OH)2D to FGF23 ratio predicted a higher risk of CV events. One in 5 (19%) patients experienced a CV event during 48 months of follow up. Nearly half of all patients had pre-existing cardiovascular disease (44%) and/or diabetes (46%), and results were adjusted accordingly. Analyses were additionally adjusted for use of angiotensin-converting enzyme inhibitors, beta blockers, and aspirin.
“Higher levels of 1,25(OH)2D and lower levels of PTH or FGF23 may be protective against adverse outcomes,” investigator Mila Tang, MSc, told Renal & Urology News. “Further exploration of biomarkers in combination may provide insights into differentiating patients with expected levels of bone mineral markers, according to their renal function, from patients with biomarker levels outside of the expected ranges that may require intervention.”
The study was funded by DiaSorin, Inc.
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Levin A, Djurdjev O, Tang M, et al. Ratios of parathyroid hormone, fibroblast growth factor 23, and 1,25-dihydroxylvitamin D and CKD progression. Presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31 to Nov. 5). Abstracts FR-PO261.
Levin A, Djurdjev O, Tang M, et al. Ratios of parathyroid hormone, fibroblast growth factor 23, and 1,25-dihydroxylvitamin D and cardiovascular events. Presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31 to Nov. 5). Abstract FR-PO262.