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

Pediatric Nephrology volume 28, pages 2035–2042 (2013)Cite this article

Abstract

Background

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.

Results

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).

Conclusion

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

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Acknowledgments

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).

Disclosures

None.

Author information

Affiliations

  1. Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th St., Miami, FL, 33136, USA

    Tamara Isakova, Jessica Houston & Eva Schiavenato

  2. Division of Pediatric Cardiology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA

    Laura Santacruz, William G. Harmon, Steven E. Lipshultz, Tracie L. Miller & Paolo G. Rusconi

  3. Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA

    Gabriel Somarriba, Steven E. Lipshultz, Tracie L. Miller & Paolo G. Rusconi

Authors
  1. Tamara Isakova
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  2. Jessica Houston
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  3. Laura Santacruz
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  4. Eva Schiavenato
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  7. Steven E. Lipshultz
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  9. Paolo G. Rusconi
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Correspondence to Tamara Isakova.

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Isakova, T., Houston, J., Santacruz, L. et al. Associations between fibroblast growth factor 23 and cardiac characteristics in pediatric heart failure. Pediatr Nephrol 28, 2035–2042 (2013). https://doi.org/10.1007/s00467-013-2515-7

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  • DOI: https://doi.org/10.1007/s00467-013-2515-7

Keywords

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