title: Elevated Fibroblast Growth Factor 23 Concentration: Prediction of Mortality among Chronic Kidney Disease Patients.
abstract: BACKGROUND
  The osteocyte-derived hormone, fibroblast growth factor 23 (FGF23), regulates the phosphorus metabolism and suppresses 1,25-dihydroxyvitamin D production, thereby mitigating hyperphosphatemia in patients with renal disorders. An elevated FGF23 level is suggested to be an early biomarker of altered phosphorus metabolism in the initial stages of chronic kidney disease (CKD) and acts as a strong predictor of mortality in dialysis patients. In the Saudi population, there is no report on the FGF23 level in CKD patients to date. This study aims to estimate the plasma FGF23 levels in the Saudi population and to correlate it with its clinical manifestations in order to ascertain its role in the pathogenesis of CKD patients.
  
  
  METHODS
  The FGF23 level in the plasma samples was determined using ELISA in a diverse cohort of 89 cases with stage 3-5 CKD and 100 healthy subjects. The plasma FGF23 level was correlated with other biochemical parameters.
  
  
  RESULTS
  The results revealed that the FGF23 level was markedly elevated among CKD patients compared to the control group, and a significant inverse correlation was observed between the FGF23 level and glomerular filtration rate. FGF23 elevation was approximately 40-fold among stage 5 patients compared to the control, while the elevation of phosphate, parathyroid hormone (PTH) and alkaline phosphatase was 2-, 3- and 8-fold in this stage, respectively.
  
  
  CONCLUSIONS
  Elevated FGF23 levels may have a strong correlation with the disease pathogenesis. In addition, FGF23 might be a future therapeutic target to intervene against the progression of CKD as well as to increase patient survivability.
authors.affiliation: Center for Research and Medical Consultation, University of Dammam, Dammam, Saudi Arabia.
authors.forename: Shahanas
authors.initials: S
authors.lastname: Chathoth
authors.affiliation: King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia.
authors.forename: Samir
authors.initials: S
authors.lastname: Al-Mueilo
authors.affiliation: Center for Research and Medical Consultation, University of Dammam, Dammam, Saudi Arabia.
authors.forename: Cyril
authors.initials: C
authors.lastname: Cyrus
authors.affiliation: Center for Research and Medical Consultation, University of Dammam, Dammam, Saudi Arabia.
authors.forename: Chittibabu
authors.initials: C
authors.lastname: Vatte
authors.affiliation: King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia.
authors.forename: Awatif
authors.initials: A
authors.lastname: Al-Nafaie
authors.affiliation: King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia.
authors.forename: Rudaynah
authors.initials: R
authors.lastname: Al-Ali
authors.affiliation: Division of Transplantation, Department of Surgery, University of Pennsylvania, Philadelphia, Pa., USA.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Keating
authors.affiliation: King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia.
authors.forename: Fahad
authors.initials: F
authors.lastname: Al-Muhanna
authors.affiliation: Center for Research and Medical Consultation, University of Dammam, Dammam, Saudi Arabia.
authors.forename: Amein
authors.initials: A
authors.lastname: Al Ali
keywords: Calcitriol; Chronic kidney disease; FGF23; Mortality; Parathyroid hormone; Phosphate