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Longitudinal FGF23 Trajectories and Mortality in Patients with CKD.

Publication ,  Journal Article
Isakova, T; Cai, X; Lee, J; Xie, D; Wang, X; Mehta, R; Allen, NB; Scialla, JJ; Pencina, MJ; Anderson, AH; Talierco, J; Chen, J; Fischer, MJ ...
Published in: J Am Soc Nephrol
February 2018

Elevated fibroblast growth factor 23 (FGF23) levels, measured at a single time, are strongly associated with increased risk of mortality in patients with CKD. There are minimal data on serial FGF23 measurements in CKD. In a prospective case-cohort study of the Chronic Renal Insufficiency Cohort, we measured FGF23 at two to five annual time points (mean 4.0±1.2) in a randomly selected subcohort of 1135 participants, of whom 203 died, and all remaining 390 participants who died through mid-2013. Higher FGF23 was independently associated with increased risk of death in multivariable-adjusted analyses of time-varying FGF23 (hazard ratio per 1-SD increase in ln-transformed FGF23, 1.84; 95% CI, 1.67 to 2.03). Median FGF23 was stable over 5 years of follow-up, but its gradually right-skewed distribution suggested a subpopulation with markedly elevated FGF23. Trajectory analysis revealed three distinct trajectories: stable FGF23 in the majority of participants (slope of lnFGF23 per year =0.03, 95% CI, 0.02 to 0.04, n=724) and smaller subpopulations with slowly (slope=0.14, 95% CI, 0.12 to 0.16, n=486) or rapidly (slope=0.46, 95% CI, 0.38 to 0.54, n=99) rising levels. Compared with stable FGF23, participants with slowly rising FGF23 trajectories were at 4.49-fold higher risk of death (95% CI, 3.17 to 6.35) and individuals with rapidly rising FGF23 trajectories were at 15.23-fold higher risk of death (95% CI, 8.24 to 28.14) in fully adjusted analyses. Trajectory analyses that used four or three annual FGF23 measurements yielded qualitatively similar results. In conclusion, FGF23 levels are stable over time in the majority of patients with CKD, but serial measurements identify subpopulations with rising levels and exceptionally high risk of death.

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

February 2018

Volume

29

Issue

2

Start / End Page

579 / 590

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Renal Insufficiency, Chronic
  • Prospective Studies
  • Middle Aged
  • Male
  • Longitudinal Studies
  • Humans
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23
 

Citation

APA
Chicago
ICMJE
MLA
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Isakova, T., Cai, X., Lee, J., Xie, D., Wang, X., Mehta, R., … Chronic Renal Insufficiency Cohort (CRIC) Study Investigators, . (2018). Longitudinal FGF23 Trajectories and Mortality in Patients with CKD. J Am Soc Nephrol, 29(2), 579–590. https://doi.org/10.1681/ASN.2017070772
Isakova, Tamara, Xuan Cai, Jungwha Lee, Dawei Xie, Xue Wang, Rupal Mehta, Norrina B. Allen, et al. “Longitudinal FGF23 Trajectories and Mortality in Patients with CKD.J Am Soc Nephrol 29, no. 2 (February 2018): 579–90. https://doi.org/10.1681/ASN.2017070772.
Isakova T, Cai X, Lee J, Xie D, Wang X, Mehta R, et al. Longitudinal FGF23 Trajectories and Mortality in Patients with CKD. J Am Soc Nephrol. 2018 Feb;29(2):579–90.
Isakova, Tamara, et al. “Longitudinal FGF23 Trajectories and Mortality in Patients with CKD.J Am Soc Nephrol, vol. 29, no. 2, Feb. 2018, pp. 579–90. Pubmed, doi:10.1681/ASN.2017070772.
Isakova T, Cai X, Lee J, Xie D, Wang X, Mehta R, Allen NB, Scialla JJ, Pencina MJ, Anderson AH, Talierco J, Chen J, Fischer MJ, Steigerwalt SP, Leonard MB, Hsu C-Y, de Boer IH, Kusek JW, Feldman HI, Wolf M, Chronic Renal Insufficiency Cohort (CRIC) Study Investigators. Longitudinal FGF23 Trajectories and Mortality in Patients with CKD. J Am Soc Nephrol. 2018 Feb;29(2):579–590.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

February 2018

Volume

29

Issue

2

Start / End Page

579 / 590

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Renal Insufficiency, Chronic
  • Prospective Studies
  • Middle Aged
  • Male
  • Longitudinal Studies
  • Humans
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23