Abstract: TH-PO1061
Intact Fibroblast Growth Factor 23 and Progression of CKD
Session Information
- CKD Progression and Complications: Diagnosis, Prognosis, Risk Factors
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Yadav, Ashok Kumar, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
- Kundu, Monica, The George Institute for Global Health India, New Delhi, Delhi, India
- Ghosh, Arpita, The George Institute for Global Health India, New Delhi, Delhi, India
- Kumar, Vivek, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
- Jha, Vivekanand, The George Institute for Global Health India, New Delhi, Delhi, India
Group or Team Name
- Indian Chronic Kidney Disease Study Group.
Background
Elevated levels of fibroblast growth factor 23 (FGF23) are associated with mortality in patients with end-stage kidney disease. Still, its relationship with adverse kidney outcomes in the early stages of chronic kidney disease is unknown. We investigated the association of intact FGF23 with the progression of CKD in the Indian Chronic Kidney Disease (ICKD) Study.
Methods
The study includes a subset of adult participants with mild to moderate CKD enrolled in ICKD study. Linear regression model was used to study the association between baselines levels of intact FGF23 and estimated glomerular filtration (eGFR) decline in the study period, adjusting for other covariates including age, gender, baseline eGFR, blood pressure, tobacco consumption and urine albumin-to-creatinine ratio. Further, to assess the association between FGF23 levels with respect to time-to-event adverse outcomes of interest, namely, major adverse kidney events (MAKE), end stage kidney disease (ESRD), ≥50% decline in eGFR, all-cause mortality, and cardiovascular (CVD) mortality, Cox proportional hazard models were used. Competing risk analysis was taken into account while fitting Cox models.
Results
A total of 605 individuals with mild to moderate CKD were included in this analysis. Mean age of the CKD patients of age was 48 years, and baseline mean eGFR was 45.8 mL/min/1.73m2. Mean (SD) follow up duration of the study was 5.33 (2.37) years with median (IQR) baseline level of intact FGF23 as 111 (78, 163) pg/ml. Baseline levels of intact FGF23 were significantly and positively associated with eGFR decline in the study period (p=0.02). Unadjusted and adjusted Cox regression models indicated that higher levels of FGF 23 were significantly associated with greater risk of MAKE (1.34; 1.15-1.56), 50% eGFR decline (1.25; 1.06 - 1.49) and ESKD (1.35; 1.13-1.62) (table 1).
Conclusion
Among individuals with mild to moderate CKD, baseline levels of intact FGF-23 are independently associated with the adverse kidney outcomes of CKD.
Table 1: Association of intact FGF23 with Outcomes in CKD patients
| Model 1 Sub-hazard ratio (95%CI) | Model 2 Sub-hazard ratio (95%CI) | Model 3 Sub-hazard ratio (95%CI) | |
| Major adverse kidney events (MAKE) | 1.39 (1.19, 1.61) P<0.01 | 1.40 (1.20, 1.63) P <0.01 | 1.34 (1.15, 1.56) P <0.01 |
| 50% eGFR decline | 1.24 (1.05, 1.45) P = 0.01 | 1.25 (1.06, 1.47) P 0.01 | 1.25 (1.06, 1.49) P = 0.01 |
| End stage kidney disease (ESKD) | 1.41 (1.19, 1.68) P<0.01 | 1.43 (1.20, 1.70) P<0.01 | 1.35 (1.13, 1.62) P<0.01 |
| All-cause mortality* | 1.28 (0.99, 1.65) P = 0.06 | 1.25 (0.96, 1.62) P = 0.10 | 1.15 (0.88, 1.48) P = 0.30 |
| CVD mortality | 0.82 (0.65, 1.04) P = 0.11 | 0.83 (0.65, 1.05) P = 0.11 | 0.85 (0.69, 1.04) P = 0.11 |
| Model 1 was unadjusted. Model 2 was adjusted for age and gender. Model 3 was adjusted for variables in model 2 + systolic BP, tobacco consumption status, estimated glomerular filtration rate and urine albumin-to-creatinine ratio. *Hazard ratio is reported | |||
Funding
- Government Support – Non-U.S.