Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease

Tamara Isakova, Patricia Wahl, Gabriela S. Vargas, Orlando M. Gutiérrez, Julia Scialla, Huiliang Xie, Dina Appleby, Lisa Nessel, Keith Bellovich, Jing Chen, Lee Hamm, Crystal Gadegbeku, Edward Horwitz, Raymond R. Townsend, Cheryl A M Anderson, James P. Lash, Chi Yuan Hsu, Mary B. Leonard, Myles Wolf

Research output: Contribution to journalArticle

623 Citations (Scopus)

Abstract

Fibroblast growth factor 23 (FGF23) regulates phosphorus metabolism and is a strong predictor of mortality in dialysis patients. FGF23 is thought to be an early biomarker of disordered phosphorus metabolism in the initial stages of chronic kidney disease (CKD). We measured FGF23 in baseline samples from 3879 patients in the Chronic Renal Insufficiency Cohort study, which is a diverse cohort of patients with CKD stage 2-4. Mean serum phosphate and median parathyroid hormone (PTH) levels were in the normal range, but median FGF23 was markedly greater than in healthy populations, and increased significantly with decreasing estimated glomerular filtration rate (eGFR). High levels of FGF23, defined as being above 100 RU/ml, were more common than secondary hyperparathyroidism and hyperphosphatemia in all strata of eGFR. The threshold of eGFR at which the slope of FGF23 increased was significantly higher than the corresponding threshold for PTH based on non-overlapping 95% confidence intervals. Thus, increased FGF23 is a common manifestation of CKD that develops earlier than increased phosphate or PTH. Hence, FGF23 measurements may be a sensitive early biomarker of disordered phosphorus metabolism in patients with CKD and normal serum phosphate levels.

Original languageEnglish
Pages (from-to)1370-1378
Number of pages9
JournalKidney International
Volume79
Issue number12
DOIs
StatePublished - Jun 1 2011

Fingerprint

Parathyroid Hormone
Chronic Renal Insufficiency
Phosphates
Glomerular Filtration Rate
Phosphorus
Biomarkers
Hyperphosphatemia
Secondary Hyperparathyroidism
fibroblast growth factor 23
Serum
Dialysis
Reference Values
Cohort Studies
Confidence Intervals
Mortality
Population

Keywords

  • chronic kidney disease
  • FGF23
  • phosphate

ASJC Scopus subject areas

  • Nephrology

Cite this

Isakova, T., Wahl, P., Vargas, G. S., Gutiérrez, O. M., Scialla, J., Xie, H., ... Wolf, M. (2011). Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease. Kidney International, 79(12), 1370-1378. https://doi.org/10.1038/ki.2011.47

Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease. / Isakova, Tamara; Wahl, Patricia; Vargas, Gabriela S.; Gutiérrez, Orlando M.; Scialla, Julia; Xie, Huiliang; Appleby, Dina; Nessel, Lisa; Bellovich, Keith; Chen, Jing; Hamm, Lee; Gadegbeku, Crystal; Horwitz, Edward; Townsend, Raymond R.; Anderson, Cheryl A M; Lash, James P.; Hsu, Chi Yuan; Leonard, Mary B.; Wolf, Myles.

In: Kidney International, Vol. 79, No. 12, 01.06.2011, p. 1370-1378.

Research output: Contribution to journalArticle

Isakova, T, Wahl, P, Vargas, GS, Gutiérrez, OM, Scialla, J, Xie, H, Appleby, D, Nessel, L, Bellovich, K, Chen, J, Hamm, L, Gadegbeku, C, Horwitz, E, Townsend, RR, Anderson, CAM, Lash, JP, Hsu, CY, Leonard, MB & Wolf, M 2011, 'Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease', Kidney International, vol. 79, no. 12, pp. 1370-1378. https://doi.org/10.1038/ki.2011.47
Isakova, Tamara ; Wahl, Patricia ; Vargas, Gabriela S. ; Gutiérrez, Orlando M. ; Scialla, Julia ; Xie, Huiliang ; Appleby, Dina ; Nessel, Lisa ; Bellovich, Keith ; Chen, Jing ; Hamm, Lee ; Gadegbeku, Crystal ; Horwitz, Edward ; Townsend, Raymond R. ; Anderson, Cheryl A M ; Lash, James P. ; Hsu, Chi Yuan ; Leonard, Mary B. ; Wolf, Myles. / Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease. In: Kidney International. 2011 ; Vol. 79, No. 12. pp. 1370-1378.
@article{1597a7b3b43747e2913fbd21b87a0994,
title = "Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease",
abstract = "Fibroblast growth factor 23 (FGF23) regulates phosphorus metabolism and is a strong predictor of mortality in dialysis patients. FGF23 is thought to be an early biomarker of disordered phosphorus metabolism in the initial stages of chronic kidney disease (CKD). We measured FGF23 in baseline samples from 3879 patients in the Chronic Renal Insufficiency Cohort study, which is a diverse cohort of patients with CKD stage 2-4. Mean serum phosphate and median parathyroid hormone (PTH) levels were in the normal range, but median FGF23 was markedly greater than in healthy populations, and increased significantly with decreasing estimated glomerular filtration rate (eGFR). High levels of FGF23, defined as being above 100 RU/ml, were more common than secondary hyperparathyroidism and hyperphosphatemia in all strata of eGFR. The threshold of eGFR at which the slope of FGF23 increased was significantly higher than the corresponding threshold for PTH based on non-overlapping 95{\%} confidence intervals. Thus, increased FGF23 is a common manifestation of CKD that develops earlier than increased phosphate or PTH. Hence, FGF23 measurements may be a sensitive early biomarker of disordered phosphorus metabolism in patients with CKD and normal serum phosphate levels.",
keywords = "chronic kidney disease, FGF23, phosphate",
author = "Tamara Isakova and Patricia Wahl and Vargas, {Gabriela S.} and Guti{\'e}rrez, {Orlando M.} and Julia Scialla and Huiliang Xie and Dina Appleby and Lisa Nessel and Keith Bellovich and Jing Chen and Lee Hamm and Crystal Gadegbeku and Edward Horwitz and Townsend, {Raymond R.} and Anderson, {Cheryl A M} and Lash, {James P.} and Hsu, {Chi Yuan} and Leonard, {Mary B.} and Myles Wolf",
year = "2011",
month = "6",
day = "1",
doi = "10.1038/ki.2011.47",
language = "English",
volume = "79",
pages = "1370--1378",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "12",

}

TY - JOUR

T1 - Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease

AU - Isakova, Tamara

AU - Wahl, Patricia

AU - Vargas, Gabriela S.

AU - Gutiérrez, Orlando M.

AU - Scialla, Julia

AU - Xie, Huiliang

AU - Appleby, Dina

AU - Nessel, Lisa

AU - Bellovich, Keith

AU - Chen, Jing

AU - Hamm, Lee

AU - Gadegbeku, Crystal

AU - Horwitz, Edward

AU - Townsend, Raymond R.

AU - Anderson, Cheryl A M

AU - Lash, James P.

AU - Hsu, Chi Yuan

AU - Leonard, Mary B.

AU - Wolf, Myles

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Fibroblast growth factor 23 (FGF23) regulates phosphorus metabolism and is a strong predictor of mortality in dialysis patients. FGF23 is thought to be an early biomarker of disordered phosphorus metabolism in the initial stages of chronic kidney disease (CKD). We measured FGF23 in baseline samples from 3879 patients in the Chronic Renal Insufficiency Cohort study, which is a diverse cohort of patients with CKD stage 2-4. Mean serum phosphate and median parathyroid hormone (PTH) levels were in the normal range, but median FGF23 was markedly greater than in healthy populations, and increased significantly with decreasing estimated glomerular filtration rate (eGFR). High levels of FGF23, defined as being above 100 RU/ml, were more common than secondary hyperparathyroidism and hyperphosphatemia in all strata of eGFR. The threshold of eGFR at which the slope of FGF23 increased was significantly higher than the corresponding threshold for PTH based on non-overlapping 95% confidence intervals. Thus, increased FGF23 is a common manifestation of CKD that develops earlier than increased phosphate or PTH. Hence, FGF23 measurements may be a sensitive early biomarker of disordered phosphorus metabolism in patients with CKD and normal serum phosphate levels.

AB - Fibroblast growth factor 23 (FGF23) regulates phosphorus metabolism and is a strong predictor of mortality in dialysis patients. FGF23 is thought to be an early biomarker of disordered phosphorus metabolism in the initial stages of chronic kidney disease (CKD). We measured FGF23 in baseline samples from 3879 patients in the Chronic Renal Insufficiency Cohort study, which is a diverse cohort of patients with CKD stage 2-4. Mean serum phosphate and median parathyroid hormone (PTH) levels were in the normal range, but median FGF23 was markedly greater than in healthy populations, and increased significantly with decreasing estimated glomerular filtration rate (eGFR). High levels of FGF23, defined as being above 100 RU/ml, were more common than secondary hyperparathyroidism and hyperphosphatemia in all strata of eGFR. The threshold of eGFR at which the slope of FGF23 increased was significantly higher than the corresponding threshold for PTH based on non-overlapping 95% confidence intervals. Thus, increased FGF23 is a common manifestation of CKD that develops earlier than increased phosphate or PTH. Hence, FGF23 measurements may be a sensitive early biomarker of disordered phosphorus metabolism in patients with CKD and normal serum phosphate levels.

KW - chronic kidney disease

KW - FGF23

KW - phosphate

UR - http://www.scopus.com/inward/record.url?scp=79957870135&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79957870135&partnerID=8YFLogxK

U2 - 10.1038/ki.2011.47

DO - 10.1038/ki.2011.47

M3 - Article

VL - 79

SP - 1370

EP - 1378

JO - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 12

ER -