title: Association of Fibroblast Growth Factor 23 With Atrial Fibrillation in Chronic Kidney Disease, From the Chronic Renal Insufficiency Cohort Study.
abstract: Levels of fibroblast growth factor 23 (FGF23) are elevated in chronic kidney disease (CKD) and strongly associated with left ventricular hypertrophy, heart failure, and death. Whether FGF23 is an independent risk factor for atrial fibrillation in CKD is unknown.
  
  
  
  To investigate the association of FGF23 with atrial fibrillation in CKD.
  
  
  
  Prospective cohort study of 3876 individuals with mild to severe CKD who enrolled in the Chronic Renal Insufficiency Cohort Study between June 19, 2003, and September 3, 2008, and were followed up through March 31, 2013.
  
  
  
  Baseline plasma FGF23 levels.
  
  
  
  Prevalent and incident atrial fibrillation.
  
  
  
  The study cohort comprised 3876 participants. Their mean (SD) age was 57.7 (11.0) years, and 44.8% (1736 of 3876) were female. Elevated FGF23 levels were independently associated with increased odds of prevalent atrial fibrillation (n = 660) after adjustment for cardiovascular and CKD-specific factors (odds ratio of highest vs lowest FGF23 quartile, 2.30; 95% CI, 1.69-3.13; P < .001 for linear trend across quartiles). During a median follow-up of 7.6 years (interquartile range, 6.3-8.6 years), 247 of the 3216 participants who were at risk developed incident atrial fibrillation (11.9 events per 1000 person-years). In fully adjusted models, elevated FGF23 was independently associated with increased risk of incident atrial fibrillation after adjustment for demographic, cardiovascular, and CKD-specific factors, and other markers of mineral metabolism (hazard ratio of highest vs lowest FGF23 quartile, 1.59; 95% CI, 1.00-2.53; P = .02 for linear trend across quartiles). The results were unchanged when further adjusted for ejection fraction, but individual adjustments for left ventricular mass index, left atrial area, and interim heart failure events partially attenuated the association of elevated FGF23 with incident atrial fibrillation.
  
  
  
  Elevated FGF23 is independently associated with prevalent and incident atrial fibrillation in patients with mild to severe CKD. The effect may be partially mediated through a diastolic dysfunction pathway that includes left ventricular hypertrophy, atrial enlargement, and heart failure events.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois2Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinbe.
authors.forename: Rupal
authors.initials: R
authors.lastname: Mehta
authors.affiliation: Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Xuan
authors.initials: X
authors.lastname: Cai
authors.affiliation: Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Jungwha
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Scialla
authors.affiliation: Division of Nephrology, Department of Medicine, University of Washington, Seattle.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: James H
authors.initials: JH
authors.lastname: Sondheimer
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: L Lee
authors.initials: LL
authors.lastname: Hamm
authors.affiliation: Division of Nephrology, Department of Medicine, University of Illinois at Chicago.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.affiliation: Division of Nephrology, Department of Medicine, Dan L. Duncan Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, Texas.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.affiliation: Division of Cardiology, Electrophysiology Section, Department of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia12Renal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.affiliation: Cardiovascular and Metabolic Conditions Section, Department of Medicine, Comprehensive Clinical Research Unit, Kaiser Permanente Northern California Division of Research, Oakland.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois2Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinbe.
authors.forename: Tamara
authors.initials: T
authors.lastname: Isakova
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois2Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinbe.
authors.forename: Myles
authors.initials: M
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D055815:Young Adult
chemical_list: C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23