Pediatric Nephrology

, Volume 28, Issue 10, pp 2035–2042 | Cite as

Associations between fibroblast growth factor 23 and cardiac characteristics in pediatric heart failure

  • Tamara IsakovaEmail author
  • Jessica Houston
  • Laura Santacruz
  • Eva Schiavenato
  • Gabriel Somarriba
  • William G. Harmon
  • Steven E. Lipshultz
  • Tracie L. Miller
  • Paolo G. Rusconi
Original Article



In adults with heart failure, elevated levels of fibroblast growth factor 23 (FGF23) are associated with mortality. Data on FGF23 levels in pediatric heart failure are lacking.

Patients and methods

We conducted a cross-sectional study of 17 healthy children (mean age 13 years) and 20 pediatric patients with heart failure (mean age 12 years) who underwent echocardiography and for whom the following measurements were taken: plasma FGF23 and parathyroid hormone (PTH) and serum phosphate, creatinine and N-terminal prohormone brain natriuretic peptide (NT-proBNP). Symptom severity was assessed with the New York Heart Association and the Ross classification systems.


Of the 20 patients, 11 had dilated cardiomyopathy, four had congenital heart disease, three had hypertrophic cardiomyopathy, one had a failing heart transplant and one had pulmonary hypertension. Mean phosphate levels in these patients were within the reported reference range for healthy children. Median PTH levels were in the normal range in patients and controls. The median FGF23 level was higher in patients versus controls (110.9 vs. 66.4 RU/ml; P = 0.03) and higher in patients on diuretics versus other patients (222.4 vs. 82.1 RU/ml; P = 0.01). Levels of FGF23 and NT-proBNP were directly correlated (r = 0.47, P = 0.04), and patients with greater physical functional impairment had higher FGF23 levels (142.5 in those with moderate-severe limitation vs. 92.8 RU/ml in those with no limitation; P = 0.05). Among patients with dilated cardiomyopathy, higher FGF23 levels were associated with a greater left ventricular end-diastolic diameter (r = 0.63, P = 0.04).


FGF23 levels are elevated in children with heart failure and are associated with diuretic use, severity of heart failure and left ventricular dilation.


Heart failure Fibroblast growth factor 23 Parathyroid hormone Diuretics N-terminal prohormone brain natriuretic peptide 



This study was supported by grants from the National Institute of Health: K23DK087858 (TI), R01HL111459, R01HL109090, R01HL053392, R01HL087000 (SEL) and R01HL095127 (TLM), and the Children’s Cardiomyopathy Foundation (SEL).




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Copyright information

© IPNA 2013

Authors and Affiliations

  • Tamara Isakova
    • 1
    Email author
  • Jessica Houston
    • 1
  • Laura Santacruz
    • 2
  • Eva Schiavenato
    • 1
  • Gabriel Somarriba
    • 3
  • William G. Harmon
    • 2
  • Steven E. Lipshultz
    • 2
    • 3
  • Tracie L. Miller
    • 2
    • 3
  • Paolo G. Rusconi
    • 2
    • 3
  1. 1.Division of Nephrology and Hypertension, Department of MedicineUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Division of Pediatric Cardiology, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Division of Pediatric Clinical Research, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiUSA

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