Elevated fibroblast growth factor 23 is a risk factor for kidney transplant loss and mortality

Myles Wolf, Miklos Z. Molnar, Ansel P. Amaral, Maria E. Czira, Anna Rudas, Akos Ujszaszi, Istvan Kiss, Laszlo Rosivall, Janos Kosa, Peter Lakatos, Csaba P. Kovesdy, Istvan Mucsi

Research output: Contribution to journalArticle

192 Citations (Scopus)

Abstract

An increased circulating level of fibroblast growth factor 23 (FGF23) is an independent risk factor for mortality, cardiovascular disease, and progression of chronic kidney disease (CKD), but its role in transplant allograft and patient survival is unknown. We tested the hypothesis that increased FGF23 is an independent risk factor for all-cause mortality and allograft loss in a prospective cohort of 984 stable kidney transplant recipients. At enrollment, estimated GFR (eGFR) was 51 ± 21 ml/min per 1.73 m2 and median C-terminal FGF23 was 28 RU/ml (interquartile range, 20 to 43 RU/ml). Higher FGF23 levels independently associated with increased risk of the composite outcome of all-cause mortality and allograft loss (full model hazard ratio: 1.46 per SD increase in logFGF23, 95% confidence interval: 1.28 to 1.68, P < 0.001). The results were similar for each component of the composite outcome and in all sensitivity analyses, including prespecified analyses of patients with baseline eGFR of 30 to 90 ml/min per 1.73 m2. In contrast, other measures of phosphorus metabolism, including serum phosphate and parathyroid hormone (PTH) levels, did not consistently associate with outcomes. We conclude that a high (or elevated) FGF23 is an independent risk factor for death and allograft loss in kidney transplant recipients.

Original languageEnglish
Pages (from-to)956-966
Number of pages11
JournalJournal of the American Society of Nephrology
Volume22
Issue number5
DOIs
Publication statusPublished - May 1 2011

ASJC Scopus subject areas

  • Nephrology

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