title: Elevated fibroblast growth factor 23 is a risk factor for kidney transplant loss and mortality.
abstract: An increased circulating level of fibroblast growth factor 23 (FGF23) is an independent risk factor for mortality, cardiovascular disease, and progression of chronic kidney disease (CKD), but its role in transplant allograft and patient survival is unknown. We tested the hypothesis that increased FGF23 is an independent risk factor for all-cause mortality and allograft loss in a prospective cohort of 984 stable kidney transplant recipients. At enrollment, estimated GFR (eGFR) was 51 ± 21 ml/min per 1.73 m(2) and median C-terminal FGF23 was 28 RU/ml (interquartile range, 20 to 43 RU/ml). Higher FGF23 levels independently associated with increased risk of the composite outcome of all-cause mortality and allograft loss (full model hazard ratio: 1.46 per SD increase in logFGF23, 95% confidence interval: 1.28 to 1.68, P<0.001). The results were similar for each component of the composite outcome and in all sensitivity analyses, including prespecified analyses of patients with baseline eGFR of 30 to 90 ml/min per 1.73 m(2). In contrast, other measures of phosphorus metabolism, including serum phosphate and parathyroid hormone (PTH) levels, did not consistently associate with outcomes. We conclude that a high (or elevated) FGF23 is an independent risk factor for death and allograft loss in kidney transplant recipients.
authors: Division of Nephrology and Hypertension, University of Miami, Miller School of Medicine, 1120 NW 14th Street, CRB 819, Miami, FL 33136, USA. mwolf2@med.miami.edu
authors: Myles
authors: M
authors: Wolf
authors: Miklos Z
authors: MZ
authors: Molnar
authors: Ansel P
authors: AP
authors: Amaral
authors: Maria E
authors: ME
authors: Czira
authors: Anna
authors: A
authors: Rudas
authors: Akos
authors: A
authors: Ujszaszi
authors: Istvan
authors: I
authors: Kiss
authors: Laszlo
authors: L
authors: Rosivall
authors: Janos
authors: J
authors: Kosa
authors: Peter
authors: P
authors: Lakatos
authors: Csaba P
authors: CP
authors: Kovesdy
authors: Istvan
authors: I
authors: Mucsi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood / Q000502:physiology*; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011446:Prospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous
chemical_list: C000717427:FGF23 protein, human; D006454:Hemoglobins; D010281:Parathyroid Hormone; D010710:Phosphates; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23