INTACT FIBROBLAST GROWTH FACTOR 23 AND MAJOR ADVERSE KIDNEY EVENTS IN CHRONIC KIDNEY DISEASE

Introduction:

Elevated levels of fibroblast growth factor 23 (FGF23) are associated with mortality in patients with end-stage kidney disease. FGF-23 levels are elevated in the early stages of  CKD, and its role in adverse outcomes of CKD has been speculated. We investigated the association of intact FGF23 with the major adverse kidney events in CKD in the Indian Chronic Kidney Disease (ICKD) Study. 

Methods:

A subset of adult participants with mild to moderate CKD enrolled in ICKD cohort were included in this study. FGF23 were analysed using ELISA. Linear regression model was used to study the association between baselines levels of intact FGF23 and estimated glomerular filtration (eGFR) decline in the study period, adjusting for other covariates including age, gender, baseline eGFR, blood pressure, tobacco consumption and urine albumin-to-creatinine ratio. Further, to assess the association between FGF23 levels with respect to time-to-event adverse outcomes of interest, namely, major adverse kidney events (MAKE), end stage kidney disease (EKRD), ≥50% decline in eGFR, all-cause mortality, and cardiovascular (CVD) mortality, Cox proportional hazard models were used. Competing risk analysis was taken into account while fitting Cox models.

Results:

A total of 605 individuals with mild to moderate CKD were included in this analysis. Mean age of the CKD patients of age was 48 years, and baseline mean eGFR was 46 mL/min/1.73m2. During a follow up period of  5.33±2.37 years, 210 (34.7%) subjects developed major adverse kidney events (MAKE). A total of 170 (28.1%) progressed to ESKD, 158 (32.5%) showed ≥ 50 decline in the eGFR and death due to kidney disease was reported in 19 (3.1%). All cause death was reported in 84 (13.9%) subjects, including CV mortality in 15 (2.5%) subjects. Baseline level of intact FGF23 was 111 (78, 163) pg/ml. Baseline levels of intact FGF23 were significantly and positively associated with eGFR decline in the study period (p=0.02). Levels of baseline iFGF-23 as per outcome events are presented in Figure 1. Unadjusted and adjusted Cox regression models indicated that higher levels of FGF 23 were significantly associated with greater risk of MAKE (1.34 ;1.15-1.56), 50% eGFR decline (1.25 ;1.06 - 1.49) and ESKD (1.35; 1.13-1.62) (table 1).

Conclusions:

Among individuals with mild to moderate CKD, baseline levels of intact FGF-23 are independently associated with the adverse kidney outcomes of CKD.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.