Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease

Tamara Isakova, Huiliang Xie, Wei Yang, Dawei Xie, Amanda Hyre Anderson, Julia Scialla, Patricia Wahl, Orlando M. Gutiérrez, Susan Steigerwalt, Jiang He, Stanley Schwartz, Joan Lo, Akinlolu Ojo, James Sondheimer, Chi Yuan Hsu, James Lash, Mary Leonard, John W. Kusek, Harold I. Feldman, Myles Wolf

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Abstract

Context: A high level of the phosphate-regulating hormone fibroblast growth factor 23 (FGF-23) is associated with mortality in patients with end-stage renal disease, but little is known about its relationship with adverse outcomes in the much larger population of patients with earlier stages of chronic kidney disease. Objective: To evaluate FGF-23 as a risk factor for adverse outcomes in patients with chronic kidney disease. Design, Setting, and Participants: A prospective study of 3879 participants with chronic kidney disease stages 2 through 4 who enrolled in the Chronic Renal Insufficiency Cohort between June 2003 and September 2008. Main Outcome Measures: All-cause mortality and end-stage renal disease. Results: At study enrollment, the mean (SD) estimated glomerular filtration rate (GFR) was 42.8 (13.5) mL/min/1.73 m2, and the median FGF-23 level was 145.5 RU/mL (interquartile range [IQR], 96-239 reference unit [RU]/mL). During a median follow-up of 3.5 years (IQR, 2.5-4.4 years), 266 participants died (20.3/1000 personyears) and 410 reached end-stage renal disease (33.0/1000 person-years). In adjusted analyses, higher levels of FGF-23 were independently associated with a greater risk of death (hazard ratio [HR], per SD of natural log-transformed FGF-23, 1.5; 95% confidence interval [CI], 1.3-1.7). Mortality risk increased by quartile of FGF-23: the HR was 1.3 (95% CI, 0.8-2.2) for the second quartile, 2.0 (95% CI, 1.2-3.3) for the third quartile, and 3.0 (95% CI, 1.8-5.1) for the fourth quartile. Elevated fibroblast growth factor 23 was independently associated with significantly higher risk of endstage renal disease among participants with an estimated GFR between 30 and 44 mL/min/1.73 m2 (HR, 1.3 per SD of FGF-23 natural log-transformed FGF-23; 95% CI, 1.04-1.6) and 45 mL/min/1.73 m2 or higher (HR, 1.7; 95% CI, 1.1-2.4), but not less than 30 mL/min/1.73 m2. Conclusion: Elevated FGF-23 is an independent risk factor for end-stage renal disease in patients with relatively preserved kidney function and for mortality across the spectrum of chronic kidney disease.

Original languageEnglish
Pages (from-to)2432-2439
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume305
Issue number23
DOIs
StatePublished - Jun 15 2011

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Chronic Renal Insufficiency
Chronic Kidney Failure
Mortality
Confidence Intervals
Glomerular Filtration Rate
fibroblast growth factor 23
Kidney
Phosphates
Outcome Assessment (Health Care)
Hormones
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)

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Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. / Isakova, Tamara; Xie, Huiliang; Yang, Wei; Xie, Dawei; Anderson, Amanda Hyre; Scialla, Julia; Wahl, Patricia; Gutiérrez, Orlando M.; Steigerwalt, Susan; He, Jiang; Schwartz, Stanley; Lo, Joan; Ojo, Akinlolu; Sondheimer, James; Hsu, Chi Yuan; Lash, James; Leonard, Mary; Kusek, John W.; Feldman, Harold I.; Wolf, Myles.

In: JAMA - Journal of the American Medical Association, Vol. 305, No. 23, 15.06.2011, p. 2432-2439.

Research output: Contribution to journalArticle

Isakova, T, Xie, H, Yang, W, Xie, D, Anderson, AH, Scialla, J, Wahl, P, Gutiérrez, OM, Steigerwalt, S, He, J, Schwartz, S, Lo, J, Ojo, A, Sondheimer, J, Hsu, CY, Lash, J, Leonard, M, Kusek, JW, Feldman, HI & Wolf, M 2011, 'Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease', JAMA - Journal of the American Medical Association, vol. 305, no. 23, pp. 2432-2439. https://doi.org/10.1001/jama.2011.826
Isakova, Tamara ; Xie, Huiliang ; Yang, Wei ; Xie, Dawei ; Anderson, Amanda Hyre ; Scialla, Julia ; Wahl, Patricia ; Gutiérrez, Orlando M. ; Steigerwalt, Susan ; He, Jiang ; Schwartz, Stanley ; Lo, Joan ; Ojo, Akinlolu ; Sondheimer, James ; Hsu, Chi Yuan ; Lash, James ; Leonard, Mary ; Kusek, John W. ; Feldman, Harold I. ; Wolf, Myles. / Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. In: JAMA - Journal of the American Medical Association. 2011 ; Vol. 305, No. 23. pp. 2432-2439.
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T1 - Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease

AU - Isakova, Tamara

AU - Xie, Huiliang

AU - Yang, Wei

AU - Xie, Dawei

AU - Anderson, Amanda Hyre

AU - Scialla, Julia

AU - Wahl, Patricia

AU - Gutiérrez, Orlando M.

AU - Steigerwalt, Susan

AU - He, Jiang

AU - Schwartz, Stanley

AU - Lo, Joan

AU - Ojo, Akinlolu

AU - Sondheimer, James

AU - Hsu, Chi Yuan

AU - Lash, James

AU - Leonard, Mary

AU - Kusek, John W.

AU - Feldman, Harold I.

AU - Wolf, Myles

PY - 2011/6/15

Y1 - 2011/6/15

N2 - Context: A high level of the phosphate-regulating hormone fibroblast growth factor 23 (FGF-23) is associated with mortality in patients with end-stage renal disease, but little is known about its relationship with adverse outcomes in the much larger population of patients with earlier stages of chronic kidney disease. Objective: To evaluate FGF-23 as a risk factor for adverse outcomes in patients with chronic kidney disease. Design, Setting, and Participants: A prospective study of 3879 participants with chronic kidney disease stages 2 through 4 who enrolled in the Chronic Renal Insufficiency Cohort between June 2003 and September 2008. Main Outcome Measures: All-cause mortality and end-stage renal disease. Results: At study enrollment, the mean (SD) estimated glomerular filtration rate (GFR) was 42.8 (13.5) mL/min/1.73 m2, and the median FGF-23 level was 145.5 RU/mL (interquartile range [IQR], 96-239 reference unit [RU]/mL). During a median follow-up of 3.5 years (IQR, 2.5-4.4 years), 266 participants died (20.3/1000 personyears) and 410 reached end-stage renal disease (33.0/1000 person-years). In adjusted analyses, higher levels of FGF-23 were independently associated with a greater risk of death (hazard ratio [HR], per SD of natural log-transformed FGF-23, 1.5; 95% confidence interval [CI], 1.3-1.7). Mortality risk increased by quartile of FGF-23: the HR was 1.3 (95% CI, 0.8-2.2) for the second quartile, 2.0 (95% CI, 1.2-3.3) for the third quartile, and 3.0 (95% CI, 1.8-5.1) for the fourth quartile. Elevated fibroblast growth factor 23 was independently associated with significantly higher risk of endstage renal disease among participants with an estimated GFR between 30 and 44 mL/min/1.73 m2 (HR, 1.3 per SD of FGF-23 natural log-transformed FGF-23; 95% CI, 1.04-1.6) and 45 mL/min/1.73 m2 or higher (HR, 1.7; 95% CI, 1.1-2.4), but not less than 30 mL/min/1.73 m2. Conclusion: Elevated FGF-23 is an independent risk factor for end-stage renal disease in patients with relatively preserved kidney function and for mortality across the spectrum of chronic kidney disease.

AB - Context: A high level of the phosphate-regulating hormone fibroblast growth factor 23 (FGF-23) is associated with mortality in patients with end-stage renal disease, but little is known about its relationship with adverse outcomes in the much larger population of patients with earlier stages of chronic kidney disease. Objective: To evaluate FGF-23 as a risk factor for adverse outcomes in patients with chronic kidney disease. Design, Setting, and Participants: A prospective study of 3879 participants with chronic kidney disease stages 2 through 4 who enrolled in the Chronic Renal Insufficiency Cohort between June 2003 and September 2008. Main Outcome Measures: All-cause mortality and end-stage renal disease. Results: At study enrollment, the mean (SD) estimated glomerular filtration rate (GFR) was 42.8 (13.5) mL/min/1.73 m2, and the median FGF-23 level was 145.5 RU/mL (interquartile range [IQR], 96-239 reference unit [RU]/mL). During a median follow-up of 3.5 years (IQR, 2.5-4.4 years), 266 participants died (20.3/1000 personyears) and 410 reached end-stage renal disease (33.0/1000 person-years). In adjusted analyses, higher levels of FGF-23 were independently associated with a greater risk of death (hazard ratio [HR], per SD of natural log-transformed FGF-23, 1.5; 95% confidence interval [CI], 1.3-1.7). Mortality risk increased by quartile of FGF-23: the HR was 1.3 (95% CI, 0.8-2.2) for the second quartile, 2.0 (95% CI, 1.2-3.3) for the third quartile, and 3.0 (95% CI, 1.8-5.1) for the fourth quartile. Elevated fibroblast growth factor 23 was independently associated with significantly higher risk of endstage renal disease among participants with an estimated GFR between 30 and 44 mL/min/1.73 m2 (HR, 1.3 per SD of FGF-23 natural log-transformed FGF-23; 95% CI, 1.04-1.6) and 45 mL/min/1.73 m2 or higher (HR, 1.7; 95% CI, 1.1-2.4), but not less than 30 mL/min/1.73 m2. Conclusion: Elevated FGF-23 is an independent risk factor for end-stage renal disease in patients with relatively preserved kidney function and for mortality across the spectrum of chronic kidney disease.

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