Abstract 20585: Association of Fibroblast Growth Factor-23 as a Predictor of Cardiovascular Outcomes
Introduction: Fibroblast growth factor (FGF)–23, a phosphate regulating hormone, accumulates in kidney disease. Patients with kidney disease have a higher incidence of cardiovascular outcomes. It is unclear if FGF-23 is a predictor of outcomes in all stages of kidney disease. Our aim was to assess the strength of the association of FGF-23 levels with cardiovascular outcomes at different stages of kidney disease.
Methods: We searched the MEDLINE database (1966 to 2016) supplemented by manual searches of bibliographies of key relevant articles. We selected all cohort studies in which FGF-23 was measured and classified them into three groups: studies from the general population without kidney disease, studies in pre-dialysis and studies in dialysis patients. Our outcomes were all-cause mortality, incident coronary heart disease and heart failure. We calculated the pooled relative risk (RR) with the corresponding 95% confidence interval (CI) for incident outcomes by using the fixed effects method comparing higher and lower tertiles of FGF-23. To compare differences in RR’s between each group or outcome we used meta-regression.
Results: Our search strategy yielded 3198 studies, 14 met our eligibility criteria, involving 11192 participants. We included 5 studies that measured FGF-23 in the general population, 5 in the pre-dialysis patients and 4 in patients undergoing dialysis. The table reports the RR’s for each stage of kidney disease and outcome. The RR of all-cause mortality was 1.92, 1.40 and 1.37 for the pre-dialysis, dialysis and general population, respectively. The meta-regression beta-coefficient was +0.23 (p<0.01) between each group for all-cause mortality and +0.56 (p<0.01) for heart failure.
Conclusions: The predictive ability of FGF23 for cardiovascular events differs by stage of kidney disease. It is useful in the pre-dialysis stage to predict all-cause mortality and heart failure. The rationale for the difference in risk deserves attention.
Author Disclosures: B. Mancero: None. J. Torres: None. A. Mancero: None. A. Palacio: None. L. Tamariz: None.
- © 2016 by American Heart Association, Inc.