Abstract
BackgroundFibroblast growth factor 23 (FGF23) is an important hormone in the regulation of phosphate metabolism. It is unclear whether FGF23 is associated with carotid artery calcification (CAAC) in predialysis patients. The present study aimed to clarify the relationship between FGF23 and CAAC in patients with chronic kidney disease (CKD) who were not on dialysis.MethodsOne-hundred ninety-five predialysis CKD patients were enrolled in this cross-sectional study. CAAC was assessed using multidetector computed tomography, and the prevalence of CAAC was examined. Intact FGF23 was measured in each patient. The risk factors for CAAC were evaluated using a logistic regression model.ResultsWe found CAAC in 66% of the patients. The prevalence of CAAC significantly increased across CKD stages: it was 37% in CKD stages 1–2, 58% in stage 3; 75% in stage 4, and 77% in stage 5 (p < 0.01). In multivariate analysis, smoking, diabetes mellitus and log FGF23 were each identified as risk factors for CAAC. The study population was divided in quartiles of FGF23 levels. Compared with the lowest FGF23 quartile, each subsequent quartile had a progressively higher odds ratio (OR) for CAAC, adjusted for confounders (ORs [95% confidence interval] of 2.34 [0.78 to 7.31], 5.28 [1.56 to 19.5], and 13.6 [2.92 to 74.6] for the second, third, and fourth quartiles, respectively.ConclusionsThe prevalence of CAAC is increased with the decline in the kidney function. FGF23 is independently related to CAAC in patients with CKD who are not on dialysis.
Highlights
Fibroblast growth factor 23 (FGF23) is an important hormone in the regulation of phosphate metabolism
These results suggest that measurement of FGF23 is more important than measurement of serum phosphorus for the detection of risk factors associated with carotid artery calcification (CAAC)
The present study showed that serum phosphate levels were significantly high only in chronic kidney disease (CKD) stage 5 patients compared with CKD stages 1–2 patients, whereas significantly higher FGF23 levels were already observed in CKD stage 3 patients compared with CKD stages 1–2 patients
Summary
Fibroblast growth factor 23 (FGF23) is an important hormone in the regulation of phosphate metabolism. It is unclear whether FGF23 is associated with carotid artery calcification (CAAC) in predialysis patients. We previously reported that there is a high prevalence of carotid artery calcification (CAAC) at the Fibroblast growth factor 23 (FGF23) is a 251-amino-acid protein secreted by osteocytes in adults [6], and it is an important regulator that maintains serum phosphorus levels within the normal range in patients with CKD by increasing urinary phosphate excretion and decreasing dietary phosphorus absorption through the inhibition of 1,25-dihydroxyvitamin D (1,25(OH)2D) synthesis [7]. The role of FGF23 in mortality and in CKD progression in patients with predialysis and in prevalent dialysis patients has been documented [11,12,13,14,15]; higher FGF23 levels are associated with higher mortality and a more rapid decline in kidney function
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