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 journalArticlepeer-review

715 Scopus citations

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 (US)
Pages (from-to)1370-1378
Number of pages9
JournalKidney international
Volume79
Issue number12
DOIs
StatePublished - Jun 2011

Keywords

  • chronic kidney disease
  • FGF23
  • phosphate

ASJC Scopus subject areas

  • Nephrology

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