title: Fibroblast growth factor 23: associations with cardiovascular disease and mortality in chronic kidney disease.
abstract: Fibroblast growth factor-23 (FGF-23) has emerged as an important hormone involved in phosphorus and vitamin D homeostasis. Chronic kidney disease (CKD) is the most common clinical condition in which FGF-23 levels are persistently and markedly elevated. Abnormal phosphate homeostasis and high circulating levels of FGF-23 are early complications of CKD. Although increases in FGF-23 levels may help maintain serum phosphate levels in the normal range in CKD, the long-term effects of its sustained elevated levels are unclear. Patients with CKD have high risks of developing end-stage renal disease (ESRD), cardiovascular disease, and premature death. Recent prospective studies in populations with predialysis CKD, ESRD on hemodialysis, and kidney transplant recipients demonstrate that elevated FGF-23 levels are independently associated with cardiovascular events and mortality. It was originally thought that FGF-23 was only a biomarker of disturbed phosphate balance; however, recent studies have shown that FGF-23 can have a direct effect on the heart, inducing left ventricular hypertrophy. This suggests that elevated FGF-23 levels may be a novel mechanism that explains the poor cardiovascular outcomes in CKD patients. Interventional studies are required in order to clarify the relation of causality between FGF-23 and cardiovascular mortality in this population.
authors.affiliation: Facultad de Medicina, Instituto de Investigaciones Metabólicas, Universidad del Salvador, Libertad 836 1 piso, 1012, Buenos Aires, Argentina, negri@casasco.com.ar.
authors.forename: Armando Luis
authors.initials: AL
authors.lastname: Negri
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006706:Homeostasis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000628:therapy; D014807:Vitamin D / Q000378:metabolism
chemical_list: C000717427:FGF23 protein, human; D010710:Phosphates; D014807:Vitamin D; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23