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Fibroblast growth factor 23: associations with cardiovascular disease and mortality in chronic kidney disease

International Urology and Nephrology volume 46, pages 9–17 (2014)Cite this article

Abstract

Fibroblast growth factor-23 (FGF-23) has emerged as an important hormone involved in phosphorus and vitamin D homeostasis. Chronic kidney disease (CKD) is the most common clinical condition in which FGF-23 levels are persistently and markedly elevated. Abnormal phosphate homeostasis and high circulating levels of FGF-23 are early complications of CKD. Although increases in FGF-23 levels may help maintain serum phosphate levels in the normal range in CKD, the long-term effects of its sustained elevated levels are unclear. Patients with CKD have high risks of developing end-stage renal disease (ESRD), cardiovascular disease, and premature death. Recent prospective studies in populations with predialysis CKD, ESRD on hemodialysis, and kidney transplant recipients demonstrate that elevated FGF-23 levels are independently associated with cardiovascular events and mortality. It was originally thought that FGF-23 was only a biomarker of disturbed phosphate balance; however, recent studies have shown that FGF-23 can have a direct effect on the heart, inducing left ventricular hypertrophy. This suggests that elevated FGF-23 levels may be a novel mechanism that explains the poor cardiovascular outcomes in CKD patients. Interventional studies are required in order to clarify the relation of causality between FGF-23 and cardiovascular mortality in this population.

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  1. Facultad de Medicina, Instituto de Investigaciones Metabólicas, Universidad del Salvador, Libertad 836 1 piso, 1012, Buenos Aires, Argentina

    Armando Luis Negri

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Negri, A.L. Fibroblast growth factor 23: associations with cardiovascular disease and mortality in chronic kidney disease. Int Urol Nephrol 46, 9–17 (2014). https://doi.org/10.1007/s11255-012-0370-2

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Keywords

  • Cardiovascular disease
  • Cardiovascular mortality
  • Chronic kidney disease
  • FGF-23
  • Ventricular hypertrophy