Mortality in CKD Linked to Hormone
High levels of a hormone that regulates phosphorus metabolism are associated with an increased risk of death in people with chronic kidney disease, researchers reported.
Surprisingly, elevated fibroblast growth factor 23 (or FGF-23) was more strongly associated with mortality than traditional cardiovascular disease- and chronic kidney disease-specific risk factors, according to Myles Wolf, MD, of the University of Miami's Miller School of Medicine in Miami, and colleagues.
The finding suggests that FGF-23 may be a novel risk factor for mortality in chronic kidney disease, Wolf and colleagues stated in the June 15 issue of the Journal of The American Medical Association.
On the other hand, the hormone was only linked with end-stage renal disease in people whose kidney function was relatively preserved at baseline, the researchers reported.
A high level of FGF-23 is known to be associated with mortality in patients with end-stage renal disease, Wolf and colleagues noted, but little is known about its link to adverse outcomes in patients with earlier kidney disease.
To help clarify the issue, they analyzed outcomes in the prospective Chronic Renal Insufficiency Cohort, whose 3,879 participants, enrolled between June 2003 and September 2008, had chronic kidney disease stages 2 through 4.
During a median follow up of 3.5 years, 266 participants died and 410 reached end-stage renal disease, for rates per 1,000 person-years of 20.3 and 33, respectively.
At baseline, the average estimated glomerular filtration rate was 42.8 ml/minute/1.73 m of body surface, the researchers reported.
And the median baseline FGF-23 level was 145.5 reference units/ml, more than three times the median of 43 reference units/ml that was seen in a population with a low prevalence of chronic kidney disease, Wolf and colleagues found.
The researchers divided participants into quartiles based on FGF-23 levels and found that the risk of death, in a fully adjusted model, rose as the hormone levels rose. Specifically, compared with the lowest quartile: The hazard ratio (HR) was 1.3 for the second quartile, but the 95% confidence interval ranged from 0.8 to 2.2. The HR was 2.0 for the third quartile with a 95% confidence interval from 1.2 to 3.3. The HR was 3.0 for the third quartile, with a 95% confidence interval from 1.8 to 5.1.
Traditional renal risk factors such as the estimated glomerular filtration rate did not influence the relationship, while including cardiovascular risk factors only changed it "minimally," the researchers reported.
Chronic Renal Insufficiency - News
CI-AKI is most commonly defined as a new onset or exacerbation of renal dysfunction after contrast administration without other identifiable causes. It is the third most common cause of hospital-acquired renal insufficiency (11% of cases) after low
To help clarify the issue, they analyzed outcomes in the prospective Chronic Renal Insufficiency Cohort, whose 3879 participants, enrolled between June 2003 and September 2008, had chronic kidney disease stages 2 through 4. During a median follow up of
The goal of the study was to assess whether FGF-23 could predict the risk for poor outcomes among 3879 patients with CKD stages II through IV who were enrolled in the Chronic Renal Insufficiency Cohort between June 2003 and September 2008.
The findings come from the Chronic Renal Insufficiency Cohort ( CRIC ) Study, led by principal investigator Harold I. Feldman, MD, MSCE, professor of Medicine, Renal Electrolyte and Hypertension Division, and professor of Epidemiology, and co-principal
Patients with an adverse neurological event were significantly older (mean 57.5 versus 47.6 years, P=0.004), had a higher incidence of chronic renal insufficiency (80% versus 55.9%, P=0.024), and had higher international normalized ratios (INR 3.46
Researchers Identify Novel Risk Factor in Chronic Kidney Disease ...
A new study led by Miller School researchers and their collaborators across the country has identified a novel risk factor, fibroblast growth factor 23 (FGF23), for predicting progression of early chronic kidney disease to end-stage renal failure and death. The finding could lead to the development of treatment interventions to prevent disease progression.
Chronic kidney disease, which occurs when there is permanent damage to the kidneys, affects more than 23 million Americans, with African-Americans and Hispanics at especially high risk. These patients are at increased risk of developing new or worsening cardiovascular disease and suffering from progression of their disease to complete loss of kidney function, which requires dialysis or kidney transplantation. Kidney disease alone also increases the risk of premature death.
Currently clinicians have limited ability to predict which of their patients with early stages of chronic kidney disease are at the highest risk of dying or developing renal failure, and treatments to prevent disease progression are only moderately successful. The UM team showed that patients with chronic kidney disease and elevated levels of FGF23, the phosphate regulating hormone, were more likely to progress to end-stage kidney disease and to die prematurely. The researchers found that elevated levels of FGF23 were more strongly predictive of risk of death than other proven risk factors.
The study, published in the June 15 issue of the Journal of the American Medical Association , is the first to look at FGF23 as a risk factor for death in the early stages of kidney disease.
“Our finding shows that elevated FGF23 is an independent predictor of death across the spectrum of chronic kidney disease and is an even stronger predictor than the traditional chronic kidney disease risk factors such as renal function and protein in the urine,” said Tamara Isakova, assistant professor of medicine in the Division of Nephrology and Hypertension.
The researchers looked at the levels of FGF23 in patients when they enrolled in the Chronic Renal Insufficiency Cohort Study (CRIC). The study was established in 2003 by the National Institute of Diabetes and Digestive and Kidney Disease to examine risk factors for kidney disease progression and cardiovascular disease in patients with chronic kidney disease. A total of 3,939 racially and ethnically diverse patients from seven clinical centers across the United States enrolled in the study and have been followed over time.
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