title: Correlates and Longitudinal Renal and Cardiovascular Implications of FGF23 Levels in HIV-Positive Individuals.
abstract: Fibroblast growth factor23 (FGF23), an early marker of kidney dysfunction, is associated with cardiovascular death. Its role in HIV-positive individuals is unknown. We measured FGF23 in 100 HIV-negative and 191 HIV-positive nondiabetic adults with normal baseline estimated glomerular filtration rate (GFR). We measured GFR by iohexol annually, albumin-creatinine ratio (ACR) every 6 months, as well as pulse wave velocity, carotid plaque, and carotid intima media thickness (IMT) at baseline and 2 years. Progressive albuminuria was defined as follow-up ACR ≥2-fold than baseline and ≥30 mg/g. Regression models assessed associations of FGF23 with baseline factors and longitudinal changes in disease markers. FGF23 levels were similar in HIV serostatus. Among HIV-positive persons, factors independently associated with higher baseline FGF23 levels included female (adjusted ratio of geometric means [95% CI],1.46 [1.21,1.76]), serum phosphorus (1.20 [1.03,1.40]), HCV (1.31 [1.10,1.56]) and non-suppressed HIV RNA (1.27 [1.01,1.76]). At baseline, FGF23 was not associated with GFR, albuminuria, carotid plaque, or carotid IMT in cross-sectionally adjusted analysis of HIV-positive individuals. However, higher baseline FGF23 was associated with progressive albuminuria (odds ratio1.48 [95% CI]:1.05,2.08) and a more rapid increase in IMT (13 μm/year, 95% CI,3,24). These findings suggest a role for FGF23 in HIV-positive populations in identifying patients at greater risk for cardiovascular and kidney disease.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America.
authors.forename: Mohamed G
authors.initials: MG
authors.lastname: Atta
authors.affiliation: Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.affiliation: Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Fine
authors.affiliation: Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America.
authors.forename: Katie
authors.initials: K
authors.lastname: Zook
authors.affiliation: Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Monroy Trujillo
authors.affiliation: Department of Medicine, Cardiovascular Medicine Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53792, United States of America.
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
authors.affiliation: Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
mesh_terms: D000328:Adult; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019562:Viral Load
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23