title: FGF-23 and osteoprotegerin are independently associated with myocardial damage in chronic kidney disease stages 3 and 4. Another link between chronic kidney disease-mineral bone disorder and the heart.
abstract: BACKGROUND
  Extra-skeletal calcification and disordered phosphate metabolism are hallmarks of chronic kidney disease-mineral bone disorder (CKD-MBD). Osteoprotegerin (OPG) and fibroblast growth factor 23 (FGF-23) are increased in chronic kidney disease (CKD) and have been associated with arterial and cardiac dysfunction and reduced survival. Troponin T (cTnT) is released from cardiac myocytes under conditions of stress and is predictive of mortality across a range of renal functions. However, the utility of this biomarker was formerly limited by the lower limit of assay detection. The introduction of a high-sensitivity assay has enabled more detailed study of myocyte stress below the previous limit of detection. We studied the association of mediators of CKD-MBD with arterial stiffness and also of these mediators and arterial stiffness with myocardial damage in patients with CKD stages 3-4.
  
  
  METHODS
  OPG and FGF-23 were measured in 200 CKD stages 3-4 patients. cTnT was measured using a high-sensitivity assay. Aortic stiffness was assessed using aortic pulse wave velocity (APWV).
  
  
  RESULTS
  Mean age was 69 ± 11 years, mean systolic and diastolic blood pressure was 151 ± 22/81 ± 11 mmHg and renal function was 33 ± 11 mL/min/1.73 m(2). OPG, FGF-23, high-sensitivity troponin T (hs-cTnT) and APWV all correlated with renal function. After multivariate analysis, OPG and age remained independently associated with aortic stiffness. OPG and FGF-23 were independently associated with hs-cTnT in addition to other non-traditional risk factors (Model R(2) = 0.596).
  
  
  CONCLUSIONS
  We have shown that changes in bone mediators and phosphate metabolism induced by CKD are independently associated with vascular and cardiomyocyte dysfunction. Our findings suggest that cardiac dysfunction may be specifically associated with such abnormalities in addition to recognized increases in vascular stiffness.
authors.affiliation: Brighton and Sussex Medical School, Brighton, UK. martin.ford@bsuh.nhs.uk
authors.forename: Martin L
authors.initials: ML
authors.lastname: Ford
authors.forename: Edward R
authors.initials: ER
authors.lastname: Smith
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Tomlinson
authors.forename: Prabal K
authors.initials: PK
authors.lastname: Chatterjee
authors.forename: Chakravarthi
authors.initials: C
authors.lastname: Rajkumar
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Holt
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D001847:Bone Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D009202:Cardiomyopathies / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000473:pathology; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000235:genetics / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D053244:Osteoprotegerin / Q000235:genetics / Q000378:metabolism*; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D020107:Troponin T / Q000235:genetics / Q000378:metabolism*; D014655:Vascular Resistance
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D053244:Osteoprotegerin; D020107:Troponin T; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23