title: Fibroblast growth factor 23, high-sensitivity cardiac troponin, and left ventricular hypertrophy in CKD.
abstract: BACKGROUND
  Detectable levels of cardiac troponins are common in individuals with chronic kidney disease (CKD), even in the absence of symptomatic cardiovascular disease. Abnormal cardiac troponin values are associated with coronary artery disease and left ventricular hypertrophy (LVH) and predict poor clinical outcomes. Elevated levels of fibroblast growth factor 23 (FGF-23) contribute to LVH in CKD. We investigated the association of FGF-23 and hs-cTnI (high-sensitivity cardiac troponin I) and hs-cTnT (high-sensitivity cardiac troponin T) levels in CKD and examined the role of LVH in this association.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  153 stable outpatients with non-dialysis-dependent CKD.
  
  
  METHODS
  The primary predictor was FGF-23 level.
  
  
  RESULTS
  hs-cTnI, hs-cTnT.
  
  
  METHODS
  FGF-23, hs-cTnI, hs-cTnT; left ventricular mass index (LVMI) assessed by echocardiography; coronary artery calcification (CAC) measured by computed tomography. LVMI and CAC were evaluated as potential mediators of the effect of FGF-23 on hs-cTnI/T.
  
  
  RESULTS
  Mean age was 64 ± 12 (SD) years, mean estimated glomerular filtration rate was 34 ± 11 mL/min/1.73 m(2), median FGF-23 level was 120 (25th-75th percentile, 79-223) reference unit (RU)/mL, median hs-cTnI level was 6.5 (25th-75th percentile, 3.5-14.5) pg/mL, and median hs-cTnT level was 16.8 (25th-75th percentile, 11.1-33.9) pg/mL. cTnI and cTnT concentrations were higher than the 99th percentile of a healthy population in 42% and 61% of patients, respectively. In unadjusted and multivariable-adjusted analyses, hs-cTnI/T levels were associated significantly with FGF-23 levels. Adjusting for LVMI, but not CAC, weakened the association of FGF-23 and hs-cTnI/T levels.
  
  
  CONCLUSIONS
  Vitamin D levels were not measured. The prevalence of coronary artery disease may have been underestimated because it was ascertained by self-report.
  
  
  CONCLUSIONS
  Minimally elevated cTnI and cTnT levels, detectable by high-sensitivity assays, are associated with elevated FGF-23 levels in stable outpatients with CKD. FGF-23-associated LVH may contribute to detectable hs-cTnI/T levels observed in non-dialysis-dependent patients with CKD.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Smith
authors.forename: Christopher
authors.initials: C
authors.lastname: deFilippi
authors.forename: Tamara
authors.initials: T
authors.lastname: Isakova
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.forename: Karen
authors.initials: K
authors.lastname: Laliberte
authors.forename: Stephen
authors.initials: S
authors.lastname: Seliger
authors.forename: Walter
authors.initials: W
authors.lastname: Kelley
authors.forename: Show-Hong
authors.initials: SH
authors.lastname: Duh
authors.forename: Michael
authors.initials: M
authors.lastname: Hise
authors.forename: Robert
authors.initials: R
authors.lastname: Christenson
authors.forename: Myles
authors.initials: M
authors.lastname: Wolf
authors.forename: James
authors.initials: J
authors.lastname: Januzzi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000453:epidemiology* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D019210:Troponin I; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23