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Stöhr R, Schuh A, Heine GH, Brandenburg V. FGF23 in Cardiovascular Disease: Innocent Bystander or Active Mediator? Front Endocrinol (Lausanne) 2018; 9:351. [PMID: 30013515 PMCID: PMC6036253 DOI: 10.3389/fendo.2018.00351] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/11/2018] [Indexed: 11/13/2022] Open
Abstract
Fibroblast growth factor-23 (FGF23) is a mainly osteocytic hormone which increases renal phosphate excretion and reduces calcitriol synthesis. These renal actions are mediated via alpha-klotho as the obligate co-receptor. Beyond these canonical "mineral metabolism" actions, FGF23 has been identified as an independent marker for cardiovascular risk in various patient populations. Previous research has linked elevated FGF23 predominantly to left-ventricular dysfunction and consecutive morbidity and mortality. Moreover, some experimental data suggest FGF23 as a direct and causal stimulator for cardiac hypertrophy via specific myocardial FGF23-receptor activation, independent from alpha-klotho. This hypothesis offers fascinating prospects in terms of therapeutic interventions, specifically in patients with chronic kidney disease (CKD) in whom the FGF23 system is strongly stimulated and in whom left-ventricular dysfunction is a major disease burden. However, novel data challenges the previous stand-alone hypothesis about a one-way road which guides unidirectionally skeletal FGF23 toward cardiotoxic effects. In fact, recent data point toward local myocardial production and release of FGF23 in cases where (acute) myocardial damage occurs. The effects of this local production and the physiological meaning are under current examination. Moreover, epidemiologic studies suggest that high FGF-23 may follow, rather than induce, myocardial disease in certain conditions. In summary, while FGF23 is an interesting link between mineral metabolism and cardiac function underlining the meaning of the bone-heart axis, more research is needed before therapeutic interventions may be considered.
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Affiliation(s)
- Robert Stöhr
- Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany
- *Correspondence: Robert Stöhr
| | - Alexander Schuh
- Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Gunnar H. Heine
- Department of Nephrology, University Hospital Homburg-Saar, Homburg, Germany
| | - Vincent Brandenburg
- Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany
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102
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Leifheit-Nestler M, Haffner D. Paracrine Effects of FGF23 on the Heart. Front Endocrinol (Lausanne) 2018; 9:278. [PMID: 29892269 PMCID: PMC5985311 DOI: 10.3389/fendo.2018.00278] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/11/2018] [Indexed: 12/17/2022] Open
Abstract
Fibroblast growth factor (FGF) 23 is a phosphaturic hormone primarily secreted by osteocytes to maintain phosphate and mineral homeostasis. In patients with and without chronic kidney disease, enhanced circulating FGF23 levels associate with pathologic cardiac remodeling, i.e., left ventricular hypertrophy (LVH) and myocardial fibrosis and increased cardiovascular mortality. Experimental studies demonstrate that FGF23 promotes hypertrophic growth of cardiac myocytes via FGF receptor 4-dependent activation of phospholipase Cγ/calcineurin/nuclear factor of activated T cell signaling independent of its co-receptor klotho. Recent studies indicate that FGF23 is also expressed in the heart, and markedly enhanced in various clinical and experimental settings of cardiac remodeling and heart failure independent of preserved or reduced renal function. On a cellular level, FGF23 is expressed in cardiac myocytes and in other non-cardiac myocytes, including cardiac fibroblasts, vascular smooth muscle and endothelial cells in coronary arteries, and in inflammatory macrophages. Current data suggest that secreted by cardiac myocytes, FGF23 can stimulate pro-fibrotic factors in myocytes to induce fibrosis-related pathways in fibroblasts and consequently cardiac fibrosis in a paracrine manner. While acting on cardiac myocytes, FGF23 directly induces pro-hypertrophic genes and promotes the progression of LVH in an autocrine and paracrine fashion. Thus, enhanced FGF23 may promote cardiac injury in various clinical settings not only by endocrine but also via paracrine/autocrine mechanisms. In this review, we discuss recent clinical and experimental data regarding molecular mechanisms of FGF23's paracrine action on the heart with respect to pathological cardiac remodeling.
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103
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Panh L, Lairez O, Ruidavets JB, Galinier M, Carrié D, Ferrières J. Coronary artery calcification: From crystal to plaque rupture. Arch Cardiovasc Dis 2017; 110:550-561. [DOI: 10.1016/j.acvd.2017.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 12/31/2022]
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Increased Levels of sRAGE in Diabetic CKD-G5D Patients: A Potential Protective Mechanism against AGE-Related Upregulation of Fibroblast Growth Factor 23 and Inflammation. Mediators Inflamm 2017; 2017:9845175. [PMID: 29147074 PMCID: PMC5632909 DOI: 10.1155/2017/9845175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/21/2017] [Accepted: 09/07/2017] [Indexed: 01/13/2023] Open
Abstract
Advanced glycation end products (AGEs) may induce cardiac remodeling in kidney disease by promoting fibroblast growth factor 23 (FGF-23) expression. Since AGEs are increased in diabetes mellitus (DM), our first aim was to evaluate the existence of any potential association between AGEs, FGF-23, inflammation, and increased cardiovascular risk in DM patients on dialysis (CKD-G5D). Secondarily, we explored the potential role of the soluble receptor for AGEs (sRAGE) as a marker of heart failure. Levels of glycated albumin (GA), sRAGE, c-terminal FGF-23 (cFGF-23), brain natriuretic peptide (BNP), and inflammatory mediators were compared between DM and non-DM CKD-G5D patients. The levels of sRAGE, cFGF-23, BNP, and proinflammatory markers were over the ranges of normality in both DM and non-DM groups. Only GA and sRAGE levels were increased in DM compared to non-DM patients. Plasma levels of sRAGE and CRP were the only independent predictors of BNP concentration. In conclusion, in DM CKD-G5D patients, sRAGE appeared to be a marker of cardiac remodeling. Indeed, its increase could be a potential protective mechanism against the increased risk of cardiovascular complications related to AGEs and inflammation. The causal relationship between sRAGE and cardiovascular risk in these patients needs to be further confirmed by mechanistic studies.
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105
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Chonchol M, Gitomer B, Isakova T, Cai X, Salusky I, Pereira R, Abebe K, Torres V, Steinman TI, Grantham JJ, Chapman AB, Schrier RW, Wolf M. Fibroblast Growth Factor 23 and Kidney Disease Progression in Autosomal Dominant Polycystic Kidney Disease. Clin J Am Soc Nephrol 2017; 12:1461-1469. [PMID: 28705885 PMCID: PMC5586583 DOI: 10.2215/cjn.12821216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/26/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Increases in fibroblast growth factor 23 precede kidney function decline in autosomal dominant polycystic kidney disease; however, the role of fibroblast growth factor 23 in autosomal dominant polycystic kidney disease has not been well characterized. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS We measured intact fibroblast growth factor 23 levels in baseline serum samples from 1002 participants in the HALT-PKD Study A (n=540; mean eGFR =91±17 ml/min per 1.73 m2) and B (n=462; mean eGFR =48±12 ml/min per 1.73 m2). We used linear mixed and Cox proportional hazards models to test associations between fibroblast growth factor 23 and eGFR decline, percentage change in height-adjusted total kidney volume, and composite of time to 50% reduction in eGFR, onset of ESRD, or death. RESULTS Median (interquartile range) intact fibroblast growth factor 23 was 44 (33-56) pg/ml in HALT-PKD Study A and 69 (50-93) pg/ml in Study B. In adjusted models, annualized eGFR decline was significantly faster in the upper fibroblast growth factor 23 quartile (Study A: quartile 4, -3.62; 95% confidence interval, -4.12 to -3.12 versus quartile 1, -2.51; 95% confidence interval, -2.71 to -2.30 ml/min per 1.73 m2; P for trend <0.001; Study B: quartile 4, -3.74; 95% confidence interval, -4.14 to -3.34 versus quartile 1, -2.78; 95% confidence interval, -2.92 to -2.63 ml/min per 1.73 m2; P for trend <0.001). In Study A, higher fibroblast growth factor 23 quartiles were associated with greater longitudinal percentage increase in height-adjusted total kidney volume in adjusted models (quartile 4, 6.76; 95% confidence interval, 5.57 to 7.96 versus quartile 1, 6.04; 95% confidence interval, 5.55 to 6.54; P for trend =0.03). In Study B, compared with the lowest quartile, the highest fibroblast growth factor 23 quartile was associated with elevated risk for the composite outcome (hazard ratio, 3.11; 95% confidence interval, 1.84 to 5.25). Addition of fibroblast growth factor 23 to a model of annualized decline in eGFR≥3.0 ml/min per 1.73 m2 did not improve risk prediction. CONCLUSIONS Higher serum fibroblast growth factor 23 concentration was associated with kidney function decline, height-adjusted total kidney volume percentage increase, and death in patients with autosomal dominant polycystic kidney disease. However, fibroblast growth factor 23 did not substantially improve prediction of rapid kidney function decline.
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Affiliation(s)
- Michel Chonchol
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Serum fibroblast growth factor-23 and incident hypertension: the Atherosclerosis Risk in Communities (ARIC) Study. J Hypertens 2017; 34:1266-72. [PMID: 27100793 DOI: 10.1097/hjh.0000000000000936] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Elevated serum fibroblast growth factor-23 (FGF23), an endogenous hormone, is associated with disturbed mineral homeostasis, cardiovascular disease, and chronic kidney disease. It is unclear whether FGF23 impacts the development of incident hypertension. We examined the association between elevated FGF23 and incident hypertension in a community-based cohort. METHOD We investigated the association of serum FGF23, measured at baseline (1990-1992), with incident hypertension at two follow-up visits (1993-1995 and 1996-1998) in 7948 middle-aged men and women without hypertension at baseline participating in the Atherosclerosis Risk in Communities Study. Incident hypertension was determined by measured blood pressure (DBP ≥ 90 mmHg or SBP ≥ 140 mmHg) and/or self-reported hypertension medication use at follow-up exams. Complementary log-log models that accounted for interval censoring were used to model the association between FGF23 and incident hypertension. RESULTS During a median follow-up of 5.9 years, 27% (2152/7948) participants developed hypertension. A nonlinear association between serum FGF23 and incident hypertension was observed; only persons in the highest decile of serum FGF23 had an increased risk of incident hypertension. After adjustment for demographics, behaviors, and adiposity, the hazard ratio for incident hypertension was 1.24 (95% confidence interval: 1.11, 1.39) for the highest decile of FGF23 compared with the lowest quintile. The association was further attenuated in the final model after adjusting for renal function (hazard ratio: 1.21, 95% confidence interval: 1.08, 1.35). CONCLUSION High levels (≥60.6 pg/ml) of FGF23 are associated with a modestly increased risk of incident hypertension in the general population, independent of kidney function.
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107
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Chen Q, Zhang Y, Ding D, Li D, Yang Y, Li Q, Chen X, Hu G, Ling W. Associations between serum calcium, phosphorus and mortality among patients with coronary heart disease. Eur J Nutr 2017; 57:2457-2467. [PMID: 28808770 DOI: 10.1007/s00394-017-1518-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/23/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE Serum calcium and phosphorus abnormalities are associated with cardiovascular disorders in general population, but evidence among patients with established coronary heart disease (CHD) is limited and controversial. This study aimed to investigate the associations of baseline serum calcium and phosphorus levels with long-term mortality risk among patients with CHD. METHODS We conducted a prospective cohort study among 3187 patients with CHD from October 2008 and December 2011 in China. Cox proportional hazards model was used to assess the associations of serum calcium and phosphorus at baseline with the risk of death. RESULTS During follow-up (mean, 4.9 years), 295 patients died, 193 of which resulted from cardiovascular causes. Multivariable-adjusted hazard ratios (HR) for each 1 mmol/L increase in serum calcium at baseline were 0.27 (95% confidence interval (CI) 0.14-0.51) for all-cause mortality and 0.26 (95% CI 0.12-0.54) for cardiovascular mortality. Patients in the highest compared to the lowest quartile of serum calcium were at lower risk of all-cause mortality (HR, 95% CI 0.57, 0.40-0.82) and cardiovascular mortality (0.50, 0.32-0.79) (both P trend < 0.001). This inverse association between serum calcium and the risk of mortality did not change when participants were stratified by sex, age groups, level of overweight, types of CHD, and history of diabetes. We also observed a graded positive association between baseline serum phosphorus and the risks of mortality. CONCLUSIONS The present study is the first to report that lower serum calcium at baseline is associated with an increased risk of all-cause and cardiovascular mortality in a Chinese coronary heart disease cohort. Further studies are required to investigate the causal relationship and actual mechanisms.
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Affiliation(s)
- Qian Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangdong, 510080, China.,Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA
| | - Yuan Zhang
- Department of Cardiology, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Ding Ding
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangdong, 510080, China
| | - Dan Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangdong, 510080, China
| | - Yunou Yang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangdong, 510080, China
| | - Qing Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangdong, 510080, China
| | - Xuechen Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangdong, 510080, China
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA.
| | - Wenhua Ling
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangdong, 510080, China.
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Abstract
The discovery of fibroblast growth factor 23 (FGF23) has provided a more complete understanding of the regulation of phosphate and mineral homeostasis in health and in chronic kidney disease. It has also offered new insights into stratification of risk of cardiovascular events and death among patients with chronic kidney disease and the general population. In this review, we provide an overview of FGF23 biology and physiology, summarize clinical outcomes that have been associated with FGF23, discuss potential mechanisms for these observations and their public health implications, and explore clinical and population health interventions that aim to reduce FGF23 levels and improve public health.
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Affiliation(s)
- Lindsay R Pool
- Center for Translational Health and Metabolism, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611;
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27703;
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109
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Qin Z, Liu X, Song M, Zhou Q, Yu J, Zhou B, Wu Y, He Y, Huang L. Fibroblast growth factor 23 as a predictor of cardiovascular and all-cause mortality in prospective studies. Atherosclerosis 2017; 261:1-11. [PMID: 28411494 DOI: 10.1016/j.atherosclerosis.2017.03.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 03/03/2017] [Accepted: 03/30/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The prognostic value of fibroblast growth factor 23 (FGF23) for mortality remains controversial. We performed a meta-analysis of cohort studies to examine the controversial relationship between FGF23 and mortality. METHODS PubMed, EMBASE, the Cochrane Library databases and reference bibliographies were searched through September 2016 to identify prospective cohort studies with relative risks (RRs) and 95% confidence intervals (CIs) for FGF23 and mortality. A random effects model was used to pool the risk estimates. A dose-response analysis of the risk for all-cause mortality associated with FGF23 was conducted using the generalized least squares trend estimation method. RESULTS Nineteen prospective cohort studies were eligible for inclusion in this meta-analysis, of which 16 reported all-cause mortality and 9 reported cardiovascular mortality. During the follow-up periods ranging from 1 to 18.6 years, 5606 deaths occurred among 22,805 participants and 2458 cardiovascular deaths occurred among 28,845 participants. Elevated FGF23 was associated with an increased risk of all-cause mortality (RR 1.68; 95% CI 1.48-1.92) and cardiovascular mortality (RR 1.68; 95% CI 1.38-2.04) with moderate heterogeneity. These associations were not markedly modified by the geographic location, follow-up length, patient predisposition, FGF23 measurement or study quality. A sensitivity analysis yielded a similar effect on the pooled risk estimate. Evidence of a nonlinear relationship between FGF23 and all-cause mortality was observed in the dose-response analysis, with the risk gradually increasing as FGF23 increased. CONCLUSIONS This meta-analysis showed that individuals with increased plasma FGF23 levels might suffer a higher risk of all-cause mortality and cardiovascular mortality.
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Affiliation(s)
- Zhexue Qin
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Xi Liu
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Mingbao Song
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Quan Zhou
- Department of Science and Education, First People's Hospital of Changde City, No. 818 Renming Road, Changde, Hunan, 415003, China
| | - Jie Yu
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Baoshang Zhou
- Department of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Yazhou Wu
- Department of Health Statistics, College of Preventive Medicine, Third Military Medical University, Chongqing, 400038, China
| | - Yongming He
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Lan Huang
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
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Grabner A, Schramm K, Silswal N, Hendrix M, Yanucil C, Czaya B, Singh S, Wolf M, Hermann S, Stypmann J, Di Marco GS, Brand M, Wacker MJ, Faul C. FGF23/FGFR4-mediated left ventricular hypertrophy is reversible. Sci Rep 2017; 7:1993. [PMID: 28512310 PMCID: PMC5434018 DOI: 10.1038/s41598-017-02068-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/12/2017] [Indexed: 12/14/2022] Open
Abstract
Fibroblast growth factor (FGF) 23 is a phosphaturic hormone that directly targets cardiac myocytes via FGF receptor (FGFR) 4 thereby inducing hypertrophic myocyte growth and the development of left ventricular hypertrophy (LVH) in rodents. Serum FGF23 levels are highly elevated in patients with chronic kidney disease (CKD), and it is likely that FGF23 directly contributes to the high rates of LVH and cardiac death in CKD. It is currently unknown if the cardiac effects of FGF23 are solely pathological, or if they potentially can be reversed. Here, we report that FGF23-induced cardiac hypertrophy is reversible in vitro and in vivo upon removal of the hypertrophic stimulus. Specific blockade of FGFR4 attenuates established LVH in the 5/6 nephrectomy rat model of CKD. Since CKD mimics a form of accelerated cardiovascular aging, we also studied age-related cardiac remodeling. We show that aging mice lacking FGFR4 are protected from LVH. Finally, FGF23 increases cardiac contractility via FGFR4, while known effects of FGF23 on aortic relaxation do not require FGFR4. Taken together, our data highlight a role of FGF23/FGFR4 signaling in the regulation of cardiac remodeling and function, and indicate that pharmacological interference with cardiac FGF23/FGFR4 signaling might protect from CKD- and age-related LVH.
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MESH Headings
- Animals
- Biopsy
- Diet
- Disease Models, Animal
- Fibroblast Growth Factor-23
- Fibroblast Growth Factors/blood
- Fibroblast Growth Factors/metabolism
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/metabolism
- Hypertrophy, Left Ventricular/pathology
- Mice
- Mice, Knockout
- Myocardial Contraction/genetics
- Myocytes, Cardiac/metabolism
- Rats
- Receptor, Fibroblast Growth Factor, Type 4/antagonists & inhibitors
- Receptor, Fibroblast Growth Factor, Type 4/metabolism
- Signal Transduction
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Affiliation(s)
- Alexander Grabner
- Katz Family Drug Discovery Center and Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina, USA
| | - Karla Schramm
- Katz Family Drug Discovery Center and Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Cell Biology and Anatomy, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Neerupma Silswal
- Department of Biomedical Sciences, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Matt Hendrix
- Department of Biomedical Sciences, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Christopher Yanucil
- Katz Family Drug Discovery Center and Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Cell Biology and Anatomy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brian Czaya
- Katz Family Drug Discovery Center and Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Cell Biology and Anatomy, University of Miami Miller School of Medicine, Miami, Florida, USA
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Saurav Singh
- Katz Family Drug Discovery Center and Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Cell Biology and Anatomy, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina, USA
| | - Sven Hermann
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Jörg Stypmann
- Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | | | - Marcus Brand
- Department of Internal Medicine D, University Hospital Münster, Münster, Germany
| | - Michael J Wacker
- Department of Biomedical Sciences, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Christian Faul
- Katz Family Drug Discovery Center and Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
- Department of Cell Biology and Anatomy, University of Miami Miller School of Medicine, Miami, Florida, USA.
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Abstract
Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular mortality, infections, and impaired cognitive function. It is characterized by excessively increased levels of the phosphaturic hormone fibroblast growth factor 23 (FGF23) and a deficiency of its co-receptor Klotho. Despite the important physiological effect of FGF23 in maintaining phosphate homeostasis, there is increasing evidence that higher FGF23 levels are a risk factor for mortality and cardiovascular disease. FGF23 directly induces left ventricular hypertrophy via activation of the FGF receptor 4/calcineurin/nuclear factor of activated T cells signaling pathway. By contrast, the impact of FGF23 on endothelial function and the development of atherosclerosis are poorly understood. The results of recent experimental studies indicate that FGF23 directly impacts on hippocampal neurons and may thereby impair learning and memory function in CKD patients. Finally, it has been shown that FGF23 interferes with the immune system by directly acting on polymorphonuclear leukocytes and macrophages. In this review, we discuss recent data from clinical and experimental studies on the extrarenal effects of FGF23 with respect to the cardiovascular, central nervous, and immune systems.
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112
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Hemodialysis is associated with higher serum FGF23 level when compared with peritoneal dialysis. Int Urol Nephrol 2017; 49:1653-1659. [PMID: 28455658 DOI: 10.1007/s11255-017-1605-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/21/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Considering the growing relevance of fibroblast growth factor-23 (FGF23) and increased cardiovascular mortality in dialysis population, an analysis was performed to assess the influence of dialysis modality (peritoneal dialysis and hemodialysis) on level of FGF23. METHODS A cross-sectional study was performed in 80 continuous ambulatory peritoneal dialysis (CAPD) and 65 hemodialysis (HD) patients without residual renal function. Levels of calcium, phosphate, parathyroid hormone and FGF23 were measured, and their correlations were analyzed. Data on demographics, dialysis modality and FGF23 level were also analyzed. RESULTS A significant correlation was found between FGF23 and serum calcium, serum phosphate and dialysis vintage in dialysis patients. Level of FGF23 was significantly higher in hemodialysis patients than that in peritoneal dialysis population. Multivariable regression revealed that, compared to CAPD, hemodialysis was found to be a predictor for higher FGF23 level, which was independent of serum calcium and phosphate level (P < 0.05). CONCLUSIONS These findings demonstrate that FGF23 levels are significantly higher in hemodialysis patients than that in peritoneal dialysis patients. We demonstrate an important association between dialysis modality (HD vs CAPD) and higher FGF23, independent of classical determinants (serum calcium and phosphate level).
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113
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Niizuma S, Iwanaga Y, Yahata T, Miyazaki S. Renocardiovascular Biomarkers: from the Perspective of Managing Chronic Kidney Disease and Cardiovascular Disease. Front Cardiovasc Med 2017; 4:10. [PMID: 28321399 PMCID: PMC5337832 DOI: 10.3389/fcvm.2017.00010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/16/2017] [Indexed: 12/17/2022] Open
Abstract
Mortality among the patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) remains high because of the very high incidence of cardiovascular disease (CVD) such as coronary artery disease, cardiac hypertrophy, and heart failure. Identifying CVD in patients with CKD/ESRD remains a significant hurdle and the early diagnosis and therapy for CVD is crucial in these patients. Therefore, it is necessary for the better management to identify and utilize cardiovascular (CV) biomarkers in profiling CVD risk and enabling stratification of early mortality. This review summarizes current evidence about renocardiovascular biomarkers: CV biomarkers in patients with CKD as well as with ESRD, emphasizing on the emerging biomarkers: B-type natriuretic peptide, cardiac troponins, copeptin, the biomarker of renal injury (neutrophil gelatinase-associated lipocalin), and the mineral and bone disorder hormone/marker (fibroblast growth factor-23). Furthermore, it discusses their potential roles especially in ESRD and in future diagnostic and therapeutic strategies for CVD in the context of managing cardiorenal syndrome.
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Affiliation(s)
| | - Yoshitaka Iwanaga
- Division of Cardiology, Kindai University Faculty of Medicine , Osakasayama , Japan
| | - Takaharu Yahata
- Department of Cardiology, Yokohama Chuo Hospital , Yokohama , Japan
| | - Shunichi Miyazaki
- Division of Cardiology, Kindai University Faculty of Medicine , Osakasayama , Japan
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Perakakis N, Farr OM, Tuccinardi D, Upadhyay J, Mantzoros CS. Research advances in metabolism 2016. Metabolism 2017; 67:41-53. [PMID: 28081777 PMCID: PMC5871911 DOI: 10.1016/j.metabol.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Nikolaos Perakakis
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Olivia M Farr
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Dario Tuccinardi
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Jagriti Upadhyay
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02130, USA
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02130, USA
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Munoz Mendoza J, Isakova T, Cai X, Bayes LY, Faul C, Scialla JJ, Lash JP, Chen J, He J, Navaneethan S, Negrea L, Rosas SE, Kretzler M, Nessel L, Xie D, Anderson AH, Raj DS, Wolf M. Inflammation and elevated levels of fibroblast growth factor 23 are independent risk factors for death in chronic kidney disease. Kidney Int 2016; 91:711-719. [PMID: 28017325 DOI: 10.1016/j.kint.2016.10.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/28/2016] [Accepted: 10/20/2016] [Indexed: 01/07/2023]
Abstract
Inflammation is a consequence of chronic kidney disease (CKD) and is associated with adverse outcomes in many clinical settings. Inflammation stimulates production of fibroblast growth factor 23 (FGF23), high levels of which are independently associated with mortality in CKD. Few large-scale prospective studies have examined inflammation and mortality in patients with CKD, and none tested the interrelationships among inflammation, FGF23, and risk of death. Therefore, we conducted a prospective investigation of 3875 participants in the Chronic Renal Insufficiency Cohort (CRIC) study with CKD stages 2 to 4 to test the associations of baseline plasma interleukin-6, high-sensitivity C-reactive protein, and FGF23 levels with all-cause mortality, censoring at the onset of end-stage renal disease. During a median follow-up of 6.9 years, 550 participants died (20.5/1000 person-years) prior to end-stage renal disease. In separate multivariable-adjusted analyses, higher levels of interleukin-6 (hazard ratio per one standard deviation increase of natural log-transformed levels) 1.35 (95% confidence interval, 1.25-1.46), C-reactive protein 1.28 (1.16-1.40), and FGF23 1.45 (1.32-1.60) were each independently associated with increased risk of death. With further adjustment for FGF23, the risks of death associated with interleukin-6 and C-reactive protein were minimally attenuated. Compared to participants in the lowest quartiles of inflammation and FGF23, the multivariable-adjusted hazard ratio of death among those in the highest quartiles of both biomarkers was 4.38 (2.65-7.23) for interleukin-6 and FGF23, and 5.54 (3.04-10.09) for C-reactive protein and FGF23. Thus, elevated levels of interleukin-6, C-reactive protein, and FGF23 are independent risk factors for mortality in CKD.
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Affiliation(s)
- Jair Munoz Mendoza
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Xuan Cai
- Division of Nephrology and Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Liz Y Bayes
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian Faul
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julia J Scialla
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - James P Lash
- Section of Nephrology, Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Jing Chen
- Section of Nephrology and Hypertension, Department of Medicine, Tulane School of Medicine, New Orleans, LA, USA
| | - Jiang He
- Section of Nephrology and Hypertension, Department of Medicine, Tulane School of Medicine, New Orleans, LA, USA
| | - Sankar Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Lavinia Negrea
- Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sylvia E Rosas
- Joslin Diabetes Center, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthias Kretzler
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Nessel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dawei Xie
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Dominic S Raj
- Division of Renal Diseases and Hypertension, George Washington University, Washington, DC, USA
| | - Myles Wolf
- Division of Nephrology and Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Clinical features of CKD-MBD in Japan: cohort studies and registry. Clin Exp Nephrol 2016; 21:9-20. [PMID: 27942882 DOI: 10.1007/s10157-016-1367-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 12/29/2022]
Abstract
Randomized controlled trials (RCTs) are essential for evidence-based medicine; however, cohort studies and registries provide an important information about risk factors and, hence, shed light on the target of laboratory parameters. The uniqueness of the current Japanese CKD-MBD guidelines lies in the lower target range of intact parathyroid hormone levels than those used in other countries, which is based on analyses of the nationwide Japan Renal Data Registry. Cohort studies were also useful in exploring risk factors of renal outcome in predialysis patients. It was revealed that low vitamin D status (very prevalent in Japan) and high fibroblast growth factor 23 (FGF23) levels predict poor renal outcome. The reported association of FGF23 levels with left ventricular hypertrophy (LVH) and heart failure observed in cohort studies may support the idea of adding the 4th component of CKD-MBD, namely, "LVH" to the three original components. When it is not feasible to conduct RCTs regarding intervention, we have no choice but to rely on observational studies with sophisticated analysis methods, such as facility-level analysis and marginal structural model minimizing indication bias. Observational studies conducted in Japan revealed that the side effects of medications for CKD-MBD, resultant compliance, and effective doses in terms of hard outcome in Japanese patients were found to be different from those in other countries. For example, the MBD-5D study confirmed the benefit of cinacalcet in terms of mortality despite its median dose of only 25 mg/day. These data are very helpful for future guidelines specific to Japanese patients with CKD.
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Kuczera P, Adamczak M, Wiecek A. Fibroblast Growth Factor-23-A Potential Uremic Toxin. Toxins (Basel) 2016; 8:toxins8120369. [PMID: 27941640 PMCID: PMC5198563 DOI: 10.3390/toxins8120369] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
Fibroblast growth factor-23 (FGF23) is a circulating member of the FGF family produced mainly by the osteocytes and osteoblasts that can act as a hormone. The main action of FGF23 is to lower phosphatemia via the reduction of urinary phosphate reabsorption and the decrease of 1,25(OH)2-D generation in the kidney. In the course of chronic kidney disease (CKD), plasma FGF23 concentration rises early, most probably to compensate the inability of the deteriorating kidneys to excrete an adequate amount of phosphate. However, this comes at the cost of FGF23-related target organ toxicity. Results of clinical studies suggest that elevated plasma FGF23 concentration is independently associated with the increased risk of CKD progression, occurrence of cardio-vascular complications, and mortality in different stages of CKD. FGF23 also contributes to cardiomyocyte hypertrophy, vascular calcification, and endothelial dysfunction. The impact of FGF23 on heart muscle is not dependent on Klotho, but rather on the PLCγ–calcineurin–NFAT (nuclear factor of activated T-cells) pathway. Among the factors increasing plasma FGF23 concentration, active vitamin D analogues play a significant role. Additionally, inflammation and iron deficiency can contribute to the increase of plasma FGF23. Among the factors decreasing plasma FGF23, dietary phosphate restriction, some intestinal phosphate binders, cinacalcet (and other calcimimetics), and nicotinamide can be enumerated. Anti-FGF23 antibodies have also recently been developed to inhibit the action of FGF23 in target organs. Still, the best way to normalize plasma FGF23 in maintenance hemodialysis patients is restoring kidney function by successful kidney transplantation.
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Affiliation(s)
- Piotr Kuczera
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice 40-027, Poland.
| | - Marcin Adamczak
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice 40-027, Poland.
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice 40-027, Poland.
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Batra J, Buttar RS, Kaur P, Kreimerman J, Melamed ML. FGF-23 and cardiovascular disease: review of literature. Curr Opin Endocrinol Diabetes Obes 2016; 23:423-429. [PMID: 27652999 PMCID: PMC6936216 DOI: 10.1097/med.0000000000000294] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review examines associations between fibroblast growth factor 23 (FGF-23) and cardiovascular disease. RECENT FINDINGS FGF-23 is a hormone produced by osteocytes and osteoblasts that aids with phosphate excretion by the kidney and acts as a negative feedback regulator for activated vitamin D synthesis. Recent studies have found associations between elevated FGF-23 levels and a number of cardiovascular diseases, including hypertension, left ventricular hypertrophy, endothelial dysfunction, cardiovascular events and mortality. CONCLUSION Recent studies have explored the possible effects of FGF-23 on the cardiovascular system. In animal and observational human studies, there is a link between elevated FGF-23 levels and multiple cardiovascular outcomes, including hypertension, left ventricular hypertrophy and cardiovascular events and mortality. Further studies are required to evaluate whether decreasing FGF-23 levels improves cardiovascular outcomes.
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Affiliation(s)
- Jasveen Batra
- Department of Medicine/Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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Humalda JK, Seiler-Mußler S, Kwakernaak AJ, Vervloet MG, Navis G, Fliser D, Heine GH, de Borst MH. Response of fibroblast growth factor 23 to volume interventions in arterial hypertension and diabetic nephropathy. Medicine (Baltimore) 2016; 95:e5003. [PMID: 27861335 PMCID: PMC5120892 DOI: 10.1097/md.0000000000005003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Fibroblast growth factor 23 (FGF-23) rises progressively in chronic kidney disease and is associated with adverse cardiovascular outcomes. FGF-23 putatively induces volume retention by upregulating the sodium-chloride cotransporter (NCC). We studied whether, conversely, interventions in volume status affect FGF-23 concentrations.We performed a post hoc analysis of 1) a prospective saline infusion study with 12 patients with arterial hypertension who received 2 L of isotonic saline over 4 hours, and 2) a randomized controlled trial with 45 diabetic nephropathy (DN) patients on background angiotensin-converting enzyme -inhibition (ACEi), who underwent 4 6-week treatment periods with add-on hydrochlorothiazide (HCT) or placebo, combined with regular sodium (RS) or low sodium (LS) diet in a cross-over design. Plasma C-terminal FGF-23 was measured by ELISA (Immutopics) after each treatment period in DN and before and after saline infusion in hypertensives.The patients with arterial hypertension were 45 ± 13 (mean ± SD) years old with an estimated glomerular filtration rate (eGFR) of 101 ± 18 mL/min/1.73 m. Isotonic saline infusion did not affect FGF-23 (before infusion: 68 median [first to third quartile: 58-97] relative unit (RU)/mL, after infusion: 67 [57-77] RU/mL, P = 0.37). DN patients were 65 ± 9 years old. During ACEi + RS treatment, eGFR was 65 ± 25 mL/min/1.73 m and albuminuria 649 mg/d (230-2008 mg/d). FGF23 level was 94 (73-141) RU/mL during ACEi therapy. FGF-23 did not change significantly by add-on HCT (99 [74-148] RU/mL), LS diet (99 [75-135] RU/mL), or their combination (111 [81-160] RU/mL, P = 0.15).Acute and chronic changes in volume status did not materially change FGF-23 in hypertensive patients and DN, respectively. Our data do not support a direct feedback loop between volume status and FGF-23 in hypertension or DN.
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Affiliation(s)
- Jelmer K. Humalda
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sarah Seiler-Mußler
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg, Germany
| | - Arjan J. Kwakernaak
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marc G. Vervloet
- Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Danilo Fliser
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg, Germany
| | - Gunnar H. Heine
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg, Germany
| | - Martin H. de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Souma N, Isakova T, Lipiszko D, Sacco RL, Elkind MSV, DeRosa JT, Silverberg SJ, Mendez AJ, Dong C, Wright CB, Wolf M. Fibroblast Growth Factor 23 and Cause-Specific Mortality in the General Population: The Northern Manhattan Study. J Clin Endocrinol Metab 2016; 101:3779-3786. [PMID: 27501282 PMCID: PMC5052338 DOI: 10.1210/jc.2016-2215] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/03/2016] [Indexed: 01/04/2023]
Abstract
CONTEXT An elevated fibroblast growth factor (FGF) 23 is an independent risk factor for cardiovascular disease and mortality in patients with kidney disease. The relationship between FGF23 and cause-specific mortality in the general population is unknown. OBJECTIVE To investigate the association of elevated FGF23 with the risk of cause-specific mortality in a racially and ethnically diverse urban general population. DESIGN, SETTING, PARTICIPANTS The Northern Manhattan Study is a population-based prospective cohort study. Residents who were > 39 years old and had no history of stroke were enrolled between 1993 and 2001. Participants with available blood samples for baseline FGF23 testing were included in the current study (n = 2525). MAIN OUTCOME MEASURES Cause-specific death events. RESULTS A total of 1198 deaths (474 vascular, 612 nonvascular, 112 unknown cause) occurred during a median follow-up of 14 years. Compared to participants in the lowest FGF23 quintile, those in the highest quintile had a 2.07-fold higher risk (95% confidence interval [CI], 1.45, 2.94) of vascular death and a 1.64-fold higher risk (95% CI, 1.22, 2.20) of nonvascular death in fully adjusted models. Higher FGF23 was independently associated with increased risk of mortality due to cancer, but only in Hispanic participants (hazard ratio per 1 unit increase in ln FGF23 of 1.87; 95% CI, 1.40, 2.50; P for interaction = .01). CONCLUSIONS Elevated FGF23 was independently associated with increased risk of vascular and nonvascular mortality in a diverse general population and with increased risk of cancer death specifically in Hispanic individuals.
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Affiliation(s)
- Nao Souma
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - David Lipiszko
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Ralph L Sacco
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Mitchell S V Elkind
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Janet T DeRosa
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Shonni J Silverberg
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Armando J Mendez
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Chuanhui Dong
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Clinton B Wright
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Myles Wolf
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032
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Tuñón J, Fernández-Fernández B, Carda R, Pello AM, Cristóbal C, Tarín N, Aceña Á, González-Casaus ML, Huelmos A, Alonso J, Lorenzo Ó, González-Parra E, Hernández-González I, Mahíllo-Fernández I, López-Bescós L, Egido J. Circulating fibroblast growth factor-23 plasma levels predict adverse cardiovascular outcomes in patients with diabetes mellitus with coronary artery disease. Diabetes Metab Res Rev 2016; 32:685-693. [PMID: 26888181 DOI: 10.1002/dmrr.2787] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/16/2016] [Accepted: 02/09/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Abnormalities of fibroblast growth factor-23 (FGF-23) plasma levels predict adverse outcomes in patients with coronary artery disease. However, FGF-23 has a different behaviour in the presence of type 2 diabetes mellitus (T2D). We explored whether the presence of T2D affects the predictive power of FGF-23. METHODS In 704 patients with stable coronary artery disease, FGF-23, calcidiol, parathormone (PTH) and phosphate plasma levels were prospectively assessed. The primary outcome was the development of acute ischemic events (acute coronary syndrome, stroke or transient ischemic attack), heart failure or death. RESULTS One hundred seventy-three (24.6%) patients had T2D, without differences in age, sex or estimated glomerular filtration rate as compared with non-diabetic patients. Serum PTH was lower and phosphate higher in T2D than in non-diabetic patients, without differences in FGF-23 or calcidiol levels. During follow-up (2.15 ± 0.99 years), 26 (15.2%) T2D and 51 (9.6%) non-diabetic patients developed the outcome (p = 0.048). T2D patients who developed the outcome had higher FGF-23 [112.0 (59.9, 167.6) vs 68.9 (54.2, 93.0) RU/mL; p = 0.002], PTH [71.3 (47.3, 106.6) vs 51.9 (40.8, 66.2) pg/mL; p = 0.004) and phosphate (3.53 ± 0.71 vs 3.25 ± 0.50 mg/dL; p = 0.017) levels than T2D subjects who remained stable. These differences were not significant in non-diabetic patients. By multivariable Cox proportional hazard model, FGF-23 predicted independently the outcome in T2D patients [hazard ratio = 1.277; 95% CI (1.132, 1.442)] but not in those without T2D. CONCLUSIONS FGF-23 plasma levels predict adverse cardiovascular outcomes in coronary artery disease patients who have T2D but not in those without T2D. This finding should be confirmed in larger studies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- José Tuñón
- IIS-Fundación Jiménez Díaz, Madrid, Spain.
- Autónoma University, Madrid, Spain.
| | | | | | | | - Carmen Cristóbal
- Hospital de Fuenlabrada, Fuenlabrada, Spain
- Rey Juan Carlos University, Alcorcón, Spain
| | - Nieves Tarín
- University Hospital of Móstoles, Móstoles, Spain
| | | | | | - Ana Huelmos
- University Hospital Fundación Alcorcón, Alcorcón, Spain
| | - Joaquín Alonso
- Rey Juan Carlos University, Alcorcón, Spain
- University Hospital of Getafe, Getafe, Spain
| | - Óscar Lorenzo
- IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | | | | | | | | | - Jesús Egido
- IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
- CIBERDEM, Madrid, Spain
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122
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González-Parra E, Aceña Á, Lorenzo Ó, Tarín N, González-Casaus ML, Cristóbal C, Huelmos A, Mahíllo-Fernández I, Pello AM, Carda R, Hernández-González I, Alonso J, Rodríguez-Artalejo F, López-Bescós L, Ortiz A, Egido J, Tuñón J. Important abnormalities of bone mineral metabolism are present in patients with coronary artery disease with a mild decrease of the estimated glomerular filtration rate. J Bone Miner Metab 2016; 34:587-98. [PMID: 26298279 DOI: 10.1007/s00774-015-0706-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
Abstract
Chronic kidney disease (CKD)-mineral and bone disorder (MBD) is characterized by increased circulating levels of parathormone (PTH) and fibroblast growth factor 23 (FGF23), bone disease, and vascular calcification, and is associated with adverse outcomes. We studied the prevalence of mineral metabolism disorders, and the potential relationship between decreased estimated glomerular filtration rate (eGFR) and CKD-MBD in coronary artery disease patients in a cross-sectional study of 704 outpatients 7.5 ± 3.0 months after an acute coronary syndrome. The mean eGFR (CKD Epidemiology Collaboration formula) was 75.8 ± 19.1 ml/min/1.73 m(2). Our patients showed lower calcidiol plasma levels than a healthy cohort from the same geographical area. In the case of men, this finding was present despite similar creatinine levels in both groups and older age of the healthy subjects. Most patients (75.6 %) had an eGFR below 90 ml/min/1.73 m(2) (eGFR categories G2-G5), with 55.3 % of patients exhibiting values of 60-89 ml/min/1.73 m(2) (G2). PTH (r = -0.3329, p < 0.0001) and FGF23 (r = -0.3641, p < 0.0001) levels inversely correlated with eGFR, whereas calcidiol levels and serum phosphate levels did not. Overall, PTH levels were above normal in 34.9 % of patients. This proportion increased from 19.4 % in G1 category patients, to 33.7 % in G2 category patients and 56.6 % in G3-G5 category patients (p < 0.001). In multivariate analysis, eGFR and calcidiol levels were the main independent determinants of serum PTH. The mean FGF23 levels were 69.9 (54.6-96.2) relative units (RU)/ml, and 33.2 % of patients had FGF23 levels above 85.5 RU/ml (18.4 % in G1 category patients, 30.0 % in G2 category patients, and 59.2 % in G3-G5 category patients; p < 0.001). In multivariate analysis, eGFR was the main predictor of FGF23 levels. Increased phosphate levels were present in 0.7 % of the whole sample: 0 % in G1 category patients, 0.3 % in G2 category patients, and 2.8 % in G3-G5 category patients (p = 0.011). Almost 90 % of patients had calcidiol insufficiency without significant differences among the different degrees of eGFR. In conclusion, in patients with coronary artery disease there is a large prevalence of increased FGF23 and PTH levels. These findings have an independent relationship with decreased eGFR, and are evident at an eGFR of 60-89 ml/min/1.73 m(2). Then, mild decreases in eGFR must be taken in consideration by the clinician because they are associated with progressive abnormalities of mineral metabolism.
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Affiliation(s)
- Emilio González-Parra
- Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Óscar Lorenzo
- Renal and Vascular Research Laboratory, IIS-Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
| | - Nieves Tarín
- Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain
| | | | - Carmen Cristóbal
- Department of Cardiology, Hospital de Fuenlabrada and Rey Juan Carlos University, Fuenlabrada, Spain
| | - Ana Huelmos
- Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Ana María Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Joaquín Alonso
- Department of Cardiology, Hospital de Fuenlabrada and Rey Juan Carlos University, Fuenlabrada, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Alberto Ortiz
- Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
| | - Jesús Egido
- Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Autónoma University, and CIBERDEM, Madrid, Spain
| | - José Tuñón
- Department of Cardiology and Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz and Autónoma University, 28040, Madrid, Spain.
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Tuñón J, González-Hernández I, Llanos-Jiménez L, Alonso-Martín J, Escudier-Villa JM, Tarín N, Cristóbal C, Sanz P, Pello AM, Aceña Á, Carda R, Orejas M, Tomás M, Beltrán P, Calero Rueda M, Marcos E, Serrano-Antolín JM, Gutiérrez-Landaluce C, Jiménez R, Cabezudo J, Curcio A, Peces-Barba G, González-Parra E, Muñoz-Siscart R, González-Casaus ML, Lorenzo A, Huelmos A, Goicolea J, Ibáñez B, Hernández G, Alonso-Pulpón LM, Farré J, Lorenzo Ó, Mahíllo-Fernández I, Egido J. Design and rationale of a multicentre, randomised, double-blind, placebo-controlled clinical trial to evaluate the effect of vitamin D on ventricular remodelling in patients with anterior myocardial infarction: the VITamin D in Acute Myocardial Infarction (VITDAMI) trial. BMJ Open 2016; 6:e011287. [PMID: 27496232 PMCID: PMC4985833 DOI: 10.1136/bmjopen-2016-011287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Decreased plasma vitamin D (VD) levels are linked to cardiovascular damage. However, clinical trials have not demonstrated a benefit of VD supplements on left ventricular (LV) remodelling. Anterior ST-elevation acute myocardial infarction (STEMI) is the best human model to study the effect of treatments on LV remodelling. We present a proof-of-concept study that aims to investigate whether VD improves LV remodelling in patients with anterior STEMI. METHODS AND ANALYSIS The VITamin D in Acute Myocardial Infarction (VITDAMI) trial is a multicentre, randomised, double-blind, placebo-controlled trial. 144 patients with anterior STEMI will be assigned to receive calcifediol 0.266 mg capsules (Hidroferol SGC)/15 days or placebo on a 2:1 basis during 12 months. PRIMARY OBJECTIVE to evaluate the effect of calcifediol on LV remodelling defined as an increase in LV end-diastolic volume ≥10% (MRI). SECONDARY OBJECTIVES change in LV end-diastolic and end-systolic volumes, ejection fraction, LV mass, diastolic function, sphericity index and size of fibrotic area; endothelial function; plasma levels of aminoterminal fragment of B-type natriuretic peptide, galectin-3 and monocyte chemoattractant protein-1; levels of calcidiol (VD metabolite) and other components of mineral metabolism (fibroblast growth factor-23 (FGF-23), the soluble form of its receptor klotho, parathormone and phosphate). Differences in the effect of VD will be investigated according to the plasma levels of FGF-23 and klotho. Treatment safety and tolerability will be assessed. This is the first study to evaluate the effect of VD on cardiac remodelling in patients with STEMI. ETHICS AND DISSEMINATION This trial has been approved by the corresponding Institutional Review Board (IRB) and National Competent Authority (Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)). It will be conducted in accordance with good clinical practice (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use - Good Clinical Practice (ICH-GCP)) requirements, ethical principles of the Declaration of Helsinki and national laws. The results will be submitted to indexed medical journals and national and international meetings. TRIAL REGISTRATION NUMBER NCT02548364; Pre-results.
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Affiliation(s)
- José Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Joaquín Alonso-Martín
- Department of Cardiology, University Hospital of Getafe, Madrid, Spain
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | | | - Nieves Tarín
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | - Carmen Cristóbal
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Petra Sanz
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Cardiology, Hospital Rey Juan Carlos, Madrid, Spain
| | - Ana M Pello
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Miguel Orejas
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Marta Tomás
- Department of Radiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Paula Beltrán
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Esther Marcos
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | | | | | - Rosa Jiménez
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Jorge Cabezudo
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Alejandro Curcio
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Germán Peces-Barba
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Pneumology, Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio González-Parra
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Antonio Lorenzo
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | - Ana Huelmos
- Department of Cardiology, Fundación Hospital Alcorcón, Madrid, Spain
| | - Javier Goicolea
- Department of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Borja Ibáñez
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - Luis M Alonso-Pulpón
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Jerónimo Farré
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Department of Medicine, Autónoma University, Madrid, Spain
| | - Óscar Lorenzo
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jesús Egido
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
- CIBERDEM, Madrid, Spain
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Alba M, Xie J, Fung A, Desai M. The effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, on mineral metabolism and bone in patients with type 2 diabetes mellitus. Curr Med Res Opin 2016; 32:1375-85. [PMID: 27046479 DOI: 10.1080/03007995.2016.1174841] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Sodium glucose co-transporter 2 (SGLT2) inhibitors lower blood glucose levels in patients with type 2 diabetes mellitus (T2DM) by increasing urinary glucose excretion. This review provides a comprehensive summary of preclinical and clinical data on the effects of the SGLT2 inhibitor canagliflozin on mineral balance and bone. METHODS Published articles and internal study reports through November 2015 were included. RESULTS In clinical studies, canagliflozin was not associated with meaningful changes in serum or urine calcium, parathyroid hormone, or vitamin D. Canagliflozin was associated with increases in serum magnesium and phosphate without changes in their urinary excretion. Increases in serum collagen type-1 beta-carboxy-telopeptide (beta-CTX), a bone resorption marker, and osteocalcin, a bone formation marker, were observed with canagliflozin. Decreases in total hip bone mineral density (BMD) of up to 1.2% were seen with canagliflozin after 2 years; no changes in BMD were seen at other skeletal sites. Changes in total hip BMD and serum beta-CTX with canagliflozin correlated with decreases in body weight. In a clinical program-wide analysis, canagliflozin was associated with increased fracture risk that was driven by a higher incidence in the cardiovascular safety study (CANVAS), with no fracture imbalance seen in pooled data from other Phase 3 studies. The fracture imbalance occurred within 12 weeks after initiating treatment, most frequently in the distal portion of the upper and lower extremities. CONCLUSIONS Across clinical studies, canagliflozin did not meaningfully affect calcium homeostasis or hormones regulating calcium homeostasis. Increases in bone turnover markers and decreases in BMD at the total hip, but not at other sites, that correlated with weight loss were seen with canagliflozin. Canagliflozin was associated with a higher fracture incidence within 12 weeks, primarily in distal extremities. Data from ongoing canagliflozin studies will provide additional information on fracture risk.
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Affiliation(s)
- Maria Alba
- a Janssen Research & Development, LLC , Raritan , NJ , USA
| | - John Xie
- a Janssen Research & Development, LLC , Raritan , NJ , USA
| | - Albert Fung
- a Janssen Research & Development, LLC , Raritan , NJ , USA
| | - Mehul Desai
- a Janssen Research & Development, LLC , Raritan , NJ , USA
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125
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Yilmaz MI, Siriopol D, Saglam M, Unal HU, Karaman M, Gezer M, Kilinc A, Eyileten T, Guler AK, Aydin İ, Vural A, Oguz Y, Covic A, Ortiz A, Kanbay M. Osteoprotegerin in Chronic Kidney Disease: Associations with Vascular Damage and Cardiovascular Events. Calcif Tissue Int 2016; 99:121-30. [PMID: 27016924 DOI: 10.1007/s00223-016-0136-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/21/2016] [Indexed: 11/25/2022]
Abstract
Vascular injury and dysfunction contribute to cardiovascular disease, the leading cause of death in patients with chronic kidney disease (CKD). Osteoprotegerin (OPG) is a soluble member of the tumor necrosis factor receptor superfamily that has been linked to atherogenesis and endothelial dysfunction. Elevated circulating OPG levels predict future cardiovascular events (CVE). Our aim was to evaluate the determinants of circulating OPG levels, to investigate the relationship between OPG and markers of vascular damage and to test whether OPG improves risk stratification for future CVE beyond traditional and renal-specific risk factors in a CKD population. 291 patients with CKD stage 1-5 not on dialysis were included in the study. In the multivariate analysis, OPG was a significant predictor for flow-mediated dilatation, but not for carotid intima media thickness levels. During follow-up (median 36 months, IQR = 32-42 months), 87 patients had CVE. In the Cox survival analysis, OPG levels were independently associated with CVE even after adjustment for traditional and renal-specific cardiovascular risk factors. The addition of OPG to a model based on commonly used cardiovascular factors significantly improved the reclassification abilities of the model for predicting CVE. We show for the first time that OPG improves risk stratification for CVE in a non-dialysis CKD population, above and beyond a model with established traditional and renal-specific cardiovascular risk factors, including estimated glomerular filtration rate and fibroblast growth factor 23.
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Affiliation(s)
| | - Dimitrie Siriopol
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Mutlu Saglam
- Department of Radiology, Gülhane School of Medicine, Ankara, Turkey
| | - Hilmi Umut Unal
- Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey
| | - Murat Karaman
- Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey
| | - Mustafa Gezer
- Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey
| | - Ali Kilinc
- Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey
| | - Tayfun Eyileten
- Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey
| | - Ahmet Kerem Guler
- Department of Biochemistry, Gülhane School of Medicine, Ankara, Turkey
| | - İbrahim Aydin
- Department of Biochemistry, Gülhane School of Medicine, Ankara, Turkey
| | - Abdulgaffar Vural
- Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey
| | - Yusuf Oguz
- Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Alberto Ortiz
- Nephrology and Hypertension Department, IIS-Fundacion Jimenez Diaz and School of Medicine, Madrid, Spain
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Topkapi, 03490, Istanbul, Turkey.
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Biragova MS, Gracheva SA, Glazunova AM, Martynov SA, Ulaynova IN, Ilyin AV, Philippov YI, Musaeva GM, Shamkhalova MS, Shestakova MV. The role of mineral and bone disorders in the development and progression of cardiac and renal pathology in patients with type 1 diabetes mellitus of long duration. Diabetes Res Clin Pract 2016; 118:29-37. [PMID: 27240104 DOI: 10.1016/j.diabres.2016.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 03/26/2016] [Accepted: 04/14/2016] [Indexed: 01/25/2023]
Abstract
AIMS The objective of our study was to evaluate the role of mineral and bone metabolism disorders associated with chronic kidney disease (MBD-CKD) in the development and progression of cardiac and renal pathology in patients with type 1 diabetes mellitus (T1DM) of long duration. METHODS We investigated 96 patients with T1DM of long duration, with CKD at different stages (0-5), including patients on hemodialysis (HD) and with kidney transplantation (KT). Along with overall clinical examination, we assessed markers of MBD (calcium, phosphorus, parathormone, vitamin D, fibroblast growth factor (FGF) 23) and levels of cardiac injury marker (atrial natriuretic peptide, NT-proBNP). Multispiral computer tomography with Agatston index calculation was also included. RESULTS Decreased kidney function was associated with increased of levels phosphorus, parathormone, FGF 23, and vitamin D deficiency, with the highest deviation from the reference ranges seen in patients on HD with a very high risk of cardiovascular events. In KT patients with satisfactory graft function, these parameters were at the same levels as in patients with CKD stages 0-4. Progression of cardiovascular pathology was accompanied by elevation of NT-proBNP levels as CKD duration increased, decreased glomerular filtration rate, and were correlated with the main parameters of mineral homeostasis. The severity of coronary arteries calcification was associated with patient age and duration of T1DM and arterial hypertension. CONCLUSIONS Development and progression of kidney dysfunction is accompanied by MBD, a significant factor in progression of cardiac pathology, which remains a major cause of mortality in this patient population.
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Affiliation(s)
- Margarita S Biragova
- Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation.
| | - Svetlana A Gracheva
- Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation.
| | - Alexandra M Glazunova
- Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation.
| | - Sergey A Martynov
- Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation.
| | - Irina N Ulaynova
- Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation.
| | - Alexandr V Ilyin
- Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation.
| | - Yury I Philippov
- Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation.
| | - Guliya M Musaeva
- I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya st., Moscow 119991, Russia.
| | - Minara S Shamkhalova
- Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation.
| | - Marina V Shestakova
- Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation; I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya st., Moscow 119991, Russia.
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Wohlfahrt P, Melenovsky V, Kotrc M, Benes J, Jabor A, Franekova J, Lemaire S, Kautzner J, Jarolim P. Association of Fibroblast Growth Factor-23 Levels and Angiotensin-Converting Enzyme Inhibition in Chronic Systolic Heart Failure. JACC-HEART FAILURE 2016; 3:829-39. [PMID: 26450001 DOI: 10.1016/j.jchf.2015.05.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/19/2015] [Accepted: 05/31/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the association of fibroblast growth factor (FGF)-23 with clinical and laboratory findings, the prognostic value of FGF-23, and the relationship between angiotensin-converting enzyme inhibitor (ACEi) therapy, FGF-23 levels, and outcomes in patients with chronic systolic heart failure (HF). BACKGROUND FGF-23 is a bone-derived hormone regulating mineral metabolism. Higher FGF-23 levels are associated with an increased risk of cardiovascular mortality or HF development. Mechanisms leading to increased FGF-23 and its prognostic value have not been thoroughly studied in HF. METHODS FGF-23 was measured in 369 patients (mean age 59 ± 11 years, 84% male) with systolic HF. Patients were followed for adverse events (e.g., death, urgent heart transplantation, ventricular assist device implantation). RESULTS Tricuspid regurgitation severity, chronic kidney disease (CKD), alkaline phosphatase concentrations, inferior vena cava dilation, and absence of ACEi therapy were independently associated with FGF-23. FGF-23 was independently associated with outcomes in patients without CKD (hazard ratio [HR]: 1.43, 95% confidence interval [CI]: 1.14 to 1.78), but not in CKD patients (HR: 1.12, 95% CI: 0.87 to 1.45). In patients without CKD and with FGF-23 in the highest tertile, ACEi therapy was associated with a lower risk of adverse events (HR: 0.42, 95% CI: 0.21 to 0.81), whereas no association was seen in the remaining patients (HR: 1.18, 95% CI: 0.52 to 2.70). CONCLUSIONS In systolic HF, elevated FGF-23 is an independent predictor of adverse events, particularly in patients with preserved renal function. The association of FGF-23 with adverse events likely reflects early alterations of renal hemodynamics and renin-angiotensin system activation. Increased FGF-23 may identify a subset of HF patients benefiting from ACEi therapy.
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Affiliation(s)
- Peter Wohlfahrt
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Benes
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Antonin Jabor
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic; 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Janka Franekova
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic; 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Sophia Lemaire
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Fibroblast growth factor 23 directly targets hepatocytes to promote inflammation in chronic kidney disease. Kidney Int 2016; 90:985-996. [PMID: 27457912 DOI: 10.1016/j.kint.2016.05.019] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/26/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022]
Abstract
Patients with chronic kidney disease (CKD) develop increased levels of the phosphate-regulating hormone, fibroblast growth factor (FGF) 23, that are associated with a higher risk of mortality. Increases in inflammatory markers are another common feature that predicts poor clinical outcomes. Elevated FGF23 is associated with higher circulating levels of inflammatory cytokines in CKD, which can stimulate osteocyte production of FGF23. Here, we studied whether FGF23 can directly stimulate hepatic production of inflammatory cytokines in the absence of α-klotho, an FGF23 coreceptor in the kidney that is not expressed by hepatocytes. By activating FGF receptor isoform 4 (FGFR4), FGF23 stimulated calcineurin signaling in cultured hepatocytes, which increased the expression and secretion of inflammatory cytokines, including C-reactive protein. Elevating serum FGF23 levels increased hepatic and circulating levels of C-reactive protein in wild-type mice, but not in FGFR4 knockout mice. Administration of an isoform-specific FGFR4 blocking antibody reduced hepatic and circulating levels of C-reactive protein in the 5/6 nephrectomy rat model of CKD. Thus, FGF23 can directly stimulate hepatic secretion of inflammatory cytokines. Our findings indicate a novel mechanism of chronic inflammation in patients with CKD and suggest that FGFR4 blockade might have therapeutic anti-inflammatory effects in CKD.
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Adema AY, de Jong MA, de Borst MH, Ter Wee PM, Vervloet MG. Phosphate Binding Therapy to Lower Serum Fibroblast-Growth-Factor-23 Concentrations in Chronic Kidney Disease: Rationale and Study Design of the Sevelamer on FGF23 Trial (SoFT). Nephron Clin Pract 2016; 134:215-220. [PMID: 27442253 DOI: 10.1159/000448184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/02/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Increased levels of phosphate and fibroblast growth factor-23 (FGF23) are strong predictors of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). Preliminary data suggest that interventions lowering gastro-intestinal phosphate uptake lowers serum FGF23 concentrations and improves cardiovascular risk and subsequently survival. However, data are lacking about the magnitude of effects, the effect in different stages of CKD and whether there is a dose-effect relationship. METHODS Therefore, the Sevelamer on FGF23 Trial (SoFT) is designed as an open-label, single-arm, clinical pilot study aiming to demonstrate the feasibility of a phosphate-restricted diet in combination with the phosphate binder sevelamer to induce an effective, predictable and sustained decrease in FGF23 level in patients with an estimated glomerular filtration rate (eGFR) of 15-90 or >90 ml/min/1.73 m2 with proteinuria >1.0 g in 24 h urine collection, despite optimally dosed RAAS blockade, without inducing hypophosphatemia using a forced uptitration treatment regimen aimed at restricting phosphate uptake.
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Haring R, Enserro D, Xanthakis V, Mitchell GF, Benjamin EJ, Hamburg NM, Sullivan L, Nauck M, Wallaschofski H, Vasan RS. Plasma Fibroblast Growth Factor 23: Clinical Correlates and Association With Cardiovascular Disease and Mortality in the Framingham Heart Study. J Am Heart Assoc 2016; 5:JAHA.116.003486. [PMID: 27385427 PMCID: PMC5015386 DOI: 10.1161/jaha.116.003486] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Fibroblast growth factor 23 (FGF23) is emerging as a novel biomarker of bone metabolism, chronic kidney disease, and cardiovascular disease (CVD). However, its clinical correlates and potential predictive role in a community‐based setting are incompletely understood. Methods and Results We evaluated participants of the Framingham Heart Study (seventh examination cycle of the Offspring cohort plus second examination cycle of the multiethnic Omni cohort) to identify clinical correlates of plasma FGF23 (N=3236) and examine its cross‐sectional association with vascular function (N=2209), and longitudinal association with 10‐year incidence of CVD (N=2823), and all‐cause mortality (N=3223). Circulating FGF23 concentrations were positively related to African‐American and Asian ethnicity, waist circumference, current smoking, serum glucose, history of CVD, and antihypertensive medication use; and negatively related to male sex, hormone replacement therapy, and estimated glomerular filtration rate. Multivariable‐adjusted cross‐sectional analyses showed no consistent association of FGF23 with vascular function measures. During a median follow‐up time of 10.8 years, 347 incident CVD events and 412 deaths occurred. Multivariable‐adjusted Cox regression models revealed a positive association of FGF23 with all‐cause mortality (hazard ratio [HR] per SD increase, 1.31; 95% CI, 1.20–1.42), but not with incident CVD (HR per SD increase, 1.05; 95% CI, 0.94–1.17). Conclusions In our large, community‐based sample, FGF23 was associated with mortality risk, but not with vascular function or incident CVD.
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Affiliation(s)
- Robin Haring
- Preventive Medicine and Epidemiology Section, Boston University School of Medicine, Boston, MA European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany
| | - Danielle Enserro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Vanessa Xanthakis
- Preventive Medicine and Epidemiology Section, Boston University School of Medicine, Boston, MA National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA
| | | | - Emelia J Benjamin
- Preventive Medicine and Epidemiology Section, Boston University School of Medicine, Boston, MA Cardiology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA Department of Epidemiology, Boston University School of Public Health, Boston, MA National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA
| | - Naomi M Hamburg
- Cardiology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Lisa Sullivan
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Greifswald, Greifswald, Germany
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ramachandran S Vasan
- Preventive Medicine and Epidemiology Section, Boston University School of Medicine, Boston, MA Cardiology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA Department of Epidemiology, Boston University School of Public Health, Boston, MA National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA
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Dhayat NA, Ackermann D, Pruijm M, Ponte B, Ehret G, Guessous I, Leichtle AB, Paccaud F, Mohaupt M, Fiedler GM, Devuyst O, Pechère-Bertschi A, Burnier M, Martin PY, Bochud M, Vogt B, Fuster DG. Fibroblast growth factor 23 and markers of mineral metabolism in individuals with preserved renal function. Kidney Int 2016; 90:648-57. [PMID: 27370409 DOI: 10.1016/j.kint.2016.04.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/21/2016] [Accepted: 04/28/2016] [Indexed: 12/01/2022]
Abstract
Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that regulates phosphate homeostasis. Circulating FGF23 is elevated in chronic kidney disease (CKD) and independently associated with poor renal and cardiovascular outcomes and mortality. Because the study of FGF23 in individuals with normal renal function has received little attention, we examined in a large, population-based study of 1128 participants the associations of FGF23 with markers of mineral metabolism and renal function. The median estimated glomerular filtration rate (eGFR) of the cohort was 105 ml/min per 1.73 m(2), and the median plasma FGF23 was 78.5 RU/ml. FGF23 increased and plasma 1,25-dihydroxyvitamin D3 decreased significantly below an eGFR threshold of 102 and 99 ml/min per 1.73 m(2), respectively. In contrast, plasma parathyroid hormone increased continuously with decreasing eGFR and was first significantly elevated at an eGFR of 126 ml/min per 1.73 m(2). On multivariable analysis adjusting for sex, age, body mass index, and GFR, FGF23 was negatively associated with 1,25-dihydroxyvitamin D3, and urinary absolute and fractional calcium excretion but not with serum calcium or parathyroid hormone. We found a positive association of FGF23 with plasma phosphate, but no association with urinary absolute or fractional phosphate excretion and, unexpectedly, a positive association with tubular maximum phosphate reabsorption/GFR. Thus, in the absence of CKD, parathyroid hormone increases earlier than FGF23 when the eGFR decreases. The increase in FGF23 occurs at a higher eGFR threshold than previously reported and is closely associated with a decrease in 1,25-dihydroxyvitamin D3. We speculate that the main demonstrable effect of FGF23 in the setting of preserved renal function is suppression of 1,25-dihydroxyvitamin D3 rather than stimulation of renal phosphate excretion.
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Affiliation(s)
- Nasser A Dhayat
- Department of Nephrology, Hypertension, and Clinical Pharmacology, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Biochemistry and Molecular Medicine, University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Daniel Ackermann
- Department of Nephrology, Hypertension, and Clinical Pharmacology, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Menno Pruijm
- Nephrology Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - Belen Ponte
- Nephrology Service, Department of Specialties of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Georg Ehret
- Cardiology Service, Department of Specialties of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland; Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Alexander Benedikt Leichtle
- Department of Laboratory Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Markus Mohaupt
- Department of Nephrology, Hypertension, and Clinical Pharmacology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Georg-Martin Fiedler
- Department of Laboratory Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Antoinette Pechère-Bertschi
- Endocrinology Service, Department of Internal Medicine Specialties, University Hospital of Geneva, Geneva, Switzerland
| | - Michel Burnier
- Nephrology Service, University Hospital of Lausanne, Lausanne, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Pierre-Yves Martin
- Nephrology Service, Department of Specialties of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Murielle Bochud
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Bruno Vogt
- Department of Nephrology, Hypertension, and Clinical Pharmacology, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Daniel G Fuster
- Department of Nephrology, Hypertension, and Clinical Pharmacology, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Biochemistry and Molecular Medicine, University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland.
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Martín-Reyes R, Franco-Peláez JA, Lorenzo Ó, González-Casaus ML, Pello AM, Aceña Á, Carda R, Martín-Ventura JL, Blanco-Colio L, Martín-Mariscal ML, Martínez-Milla J, Villa-Bellosta R, Piñero A, Navarro F, Egido J, Tuñón J. Plasma Levels of Monocyte Chemoattractant Protein-1, n-Terminal Fragment of Brain Natriuretic Peptide and Calcidiol Are Independently Associated with the Complexity of Coronary Artery Disease. PLoS One 2016; 11:e0152816. [PMID: 27171378 PMCID: PMC4865225 DOI: 10.1371/journal.pone.0152816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives We investigated the relationship of the Syntax Score (SS) and coronary artery calcification (CAC), with plasma levels of biomarkers related to cardiovascular damage and mineral metabolism, as there is sparse information in this field. Methods We studied 270 patients with coronary disease that had an acute coronary syndrome (ACS) six months before. Calcidiol, fibroblast growth factor-23, parathormone, phosphate and monocyte chemoattractant protein-1 [MCP-1], high-sensitivity C-reactive protein, galectin-3, and N-terminal pro-brain natriuretic peptide [NT-proBNP] levels, among other biomarkers, were determined. CAC was assessed by coronary angiogram as low-grade (0–1) and high-grade (2–3) calcification, measured with a semiquantitative scale ranging from 0 (none) to 3 (severe). For the SS study patients were divided in SS<14 and SS≥14. Multivariate linear and logistic regression analyses were performed. Results MCP-1 predicted independently the SS (RC = 1.73 [95%CI = 0.08–3.39]; p = 0.040), along with NT-proBNP (RC = 0.17 [95%CI = 0.05–0.28]; p = 0.004), male sex (RC = 4.15 [95%CI = 1.47–6.83]; p = 0.003), age (RC = 0.13 [95%CI = 0.02–0.24]; p = 0.020), hypertension (RC = 3.64, [95%CI = 0.77–6.50]; p = 0.013), hyperlipidemia (RC = 2.78, [95%CI = 0.28–5.29]; p = 0.030), and statins (RC = 6.12 [95%CI = 1.28–10.96]; p = 0.013). Low calcidiol predicted high-grade calcification independently (OR = 0.57 [95% CI = 0.36–0.90]; p = 0.013) along with ST-elevation myocardial infarction (OR = 0.38 [95%CI = 0.19–0.78]; p = 0.006), diabetes (OR = 2.35 [95%CI = 1.11–4.98]; p = 0.028) and age (OR = 1.37 [95%CI = 1.18–1.59]; p<0.001). During follow-up (1.79 [0.94–2.86] years), 27 patients developed ACS, stroke, or transient ischemic attack. A combined score using SS and CAC predicted independently the development of the outcome. Conclusions MCP-1 and NT-proBNP are independent predictors of SS, while low calcidiol plasma levels are associated with CAC. More studies are needed to confirm these data.
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Affiliation(s)
- Roberto Martín-Reyes
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- * E-mail:
| | | | - Óscar Lorenzo
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | | | - Ana María Pello
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - José Luis Martín-Ventura
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | - Luis Blanco-Colio
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Juan Martínez-Milla
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Ricardo Villa-Bellosta
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio Piñero
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Felipe Navarro
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Egido
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
- Department of Nephrology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- CIBERDEM, Madrid, Spain
| | - José Tuñón
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
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Li DJ, Fu H, Zhao T, Ni M, Shen FM. Exercise-stimulated FGF23 promotes exercise performance via controlling the excess reactive oxygen species production and enhancing mitochondrial function in skeletal muscle. Metabolism 2016; 65:747-756. [PMID: 27085781 DOI: 10.1016/j.metabol.2016.02.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Physical exercise induces many adaptive changes in skeletal muscle and the whole body and improves metabolic characteristics. Fibroblast growth-factor 23 (FGF23) is a unique member of the FGF family that acts as a hormone regulating phosphate metabolism, calcitriol concentration, and kidney functions. The role of FGF23 in exercise and skeletal muscle is largely unknown yet. MATERIALS AND METHODS C57BL/6J mice were exercised on a motor treadmill. Mice serum FGF23 levels; FGF23 mRNA expression in various organs including the liver, heart, skeletal muscle tissue, and thyroid; and FGF23 receptor Klotho mRNA expression were examined using enzyme-linked immunosorbent assay, real-time polymerase chain reaction, and immunoblotting, respectively, after a single bout of acute exercise (60min), exhaustive exercise, and chronic prolonged exercise (60min every day for one week). C57BL/6J mice were injected with recombinant FGF23 (100mg/kg, twice per day, i.p.) or vehicle control (saline) for 3days, and then the exercise performance, reactive oxygen species (ROS), H2O2 production, and mitochondrial functional biomarkers in muscle (gene expression of sirtuin 1, PPAR-δ, PGC-1α and mitochondrial transcription factor A [TFAM], and citrate synthase activity) were assayed. RESULTS Three forms of exercise, acute exercise, exhaustive exercise, and chronic exercise, increased serum FGF23 levels. However, only chronic exercise upregulated FGF23 mRNA and protein expression in skeletal muscle. FGF23 mRNA expression in the heart, liver, and thyroid was not affected. FGF23 protein was mainly located in the cytoplasm in skeletal muscle tissue and the localization of FGF23 was not altered by exercise. Exogenous FGF23 treatment significantly extended the time to exhaustion and reduced the exercise-induced ROS and H2O2 production. FGF23 treatment increased the mRNA level of PPAR-δ and citrate synthase activity, but did not influence the mRNA expression of sirtuin 1, PGC-1α, and TFAM in skeletal muscle. CONCLUSION These results demonstrate that exercise-stimulated FGF23 promotes exercise performance via controlling the excess ROS production and enhancing mitochondrial function in skeletal muscle, which reveals an entirely novel role of FGF23 in skeletal muscle.
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Affiliation(s)
- Dong-Jie Li
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Hui Fu
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Ting Zhao
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Min Ni
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Fu-Ming Shen
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China.
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Hu X, Ma X, Pan X, Hao Y, Luo Y, Lu Z, Bao Y, Jia W. Fibroblast growth factor 23 is associated with the presence of coronary artery disease and the number of stenotic vessels. Clin Exp Pharmacol Physiol 2016. [PMID: 26217893 DOI: 10.1111/1440-1681.12467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Fibroblast growth factor 23 (FGF23) has been reported to be involved in cardiovascular disease. The aim of this study was to investigate the association between FGF23 and the presence of coronary artery disease (CAD), as well as the number of stenotic vessels. A total of 254 eligible participants (167 men and 87 postmenopausal women) were enrolled in this study. Coronary angiography was used for diagnosis of CAD. Serum intact FGF23 levels were determined by a two-sided sandwich enzyme-linked immunosorbent assay. The median serum FGF23 levels of the entire study population were 39.9 (33.1-47.5) pg/mL. Serum FGF23 levels were higher in subjects with one-vessel disease than those without CAD (P < 0.05), which further increased significantly in the subjects with multi-vessel disease (P < 0.05). Serum FGF23 levels increased with cumulative number of stenotic vessels (P for trend < 0.001). Multiple stepwise regression analysis revealed estimated glomerular filtration rate (standardized β = -0.298; P < 0.001) and body mass index (standardized β = 0.132; P = 0.049) were independent factors correlated with FGF23. Multivariate logistic regression analysis showed that FGF23 was positively and independently associated with the presence of CAD (odds ratio = 1.058, 95% confidence interval = 1.025-1.092; P = 0.001). Additionally, FGF23 was also correlated with multi-vessel disease significantly (odds ratio = 1.034, 95% confidence interval = 1.007-1.062; P = 0.013). In conclusion, serum FGF23 levels exhibit positive and independent association with the presence of CAD and increase with the cumulative number of stenotic vessels.
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Affiliation(s)
- Xiang Hu
- Departments of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Centre for Diabetes, Shanghai Key Clinical Centre for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Xiaojing Ma
- Departments of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Centre for Diabetes, Shanghai Key Clinical Centre for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Xiaoping Pan
- Departments of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Centre for Diabetes, Shanghai Key Clinical Centre for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yaping Hao
- Departments of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Centre for Diabetes, Shanghai Key Clinical Centre for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yuqi Luo
- Departments of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Centre for Diabetes, Shanghai Key Clinical Centre for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Zhigang Lu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuqian Bao
- Departments of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Centre for Diabetes, Shanghai Key Clinical Centre for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Weiping Jia
- Departments of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Centre for Diabetes, Shanghai Key Clinical Centre for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
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Isakova T, Cai X, Lee J, Katz R, Cauley JA, Fried LF, Hoofnagle AN, Satterfield S, Harris TB, Shlipak MG, Sarnak MJ, Ix JH. Associations of FGF23 With Change in Bone Mineral Density and Fracture Risk in Older Individuals. J Bone Miner Res 2016; 31:742-8. [PMID: 26590361 PMCID: PMC5564422 DOI: 10.1002/jbmr.2750] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/09/2015] [Accepted: 11/18/2015] [Indexed: 01/25/2023]
Abstract
Elevated levels of the phosphate-regulating hormone fibroblast growth factor 23 (FGF23) have been linked to greater risk of fractures in some studies, especially among individuals with chronic kidney disease (CKD). We evaluated FGF23 as a risk factor for bone loss and fractures in the Health, Aging, and Body Composition (Health ABC) study, which is a prospective biracial cohort of well-functioning adults aged 70 to 79 years recruited at two clinical centers in the United States. The sample for the bone mineral density (BMD) analyses consisted of 2234 participants who had at least two serial total hip areal BMD measures. The fracture analyses included 2786 participants, 567 of whom sustained a fracture during a median follow up of 4.95 years. Linear mixed-effects models were used for longitudinal measurements of total hip areal BMD and the proportional subdistribution hazard regression model subject to competing risks of death was used for risk of fracture. The median FGF23 was 46.7 (interquartile range [IQR] 36.7 to 60.2) pg/mL. The mean annualized percent change in total hip areal BMD did not vary significantly according to FGF23 quartile in all participants (p for trend = 0.70), but the effect was modified by CKD status (adjusted p for interaction <0.001). Among participants with CKD, the unadjusted mean annualized percent change in total hip areal BMD was greater with higher levels of FGF23 (unadjusted p for trend = 0.02), but the trend was attenuated with adjustment for estimated glomerular filtration rate and parathyroid hormone (adjusted p for trend = 0.30). FGF23 was not significantly associated with fracture risk in crude (hazard ratio [HR] per doubling of FGF23, 0.97; 95% CI, 0.85 to 1.12) or adjusted models (HR per doubling of FGF23, 1.02; 95% CI, 0.86 to 1.22), and these findings were not modified by gender or CKD status. FGF23 levels are not associated with bone loss or fracture risk in older adults with low prevalence of CKD.
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Affiliation(s)
- Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Xuan Cai
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jungwha Lee
- Division of Biostatistics, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda F Fried
- Renal Section, VA Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew N Hoofnagle
- Kidney Research Institute, University of Washington, Seattle, WA, USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee, Memphis, TN, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Rockville, MD, USA
| | - Michael G Shlipak
- Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, and Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System and Division of Nephrology and Preventive Medicine, University of California, San Diego, San Diego, CA, USA
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Phosphate and FGF23 in the renoprotective benefit of RAAS inhibition. Pharmacol Res 2016; 106:87-91. [DOI: 10.1016/j.phrs.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/07/2016] [Accepted: 02/15/2016] [Indexed: 01/15/2023]
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Epidemiologic insights on the role of fibroblast growth factor 23 in cardiovascular disease. Curr Opin Nephrol Hypertens 2016; 24:260-7. [PMID: 26066475 DOI: 10.1097/mnh.0000000000000123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Fibroblast growth factor 23 (FGF23) regulates phosphate and vitamin D homeostasis and rises as kidney function declines. Animal studies have demonstrated direct and indirect effects of FGF23 that may promote heart disease. Herein, we review the recent epidemiologic literature evaluating the relationship between FGF23 and cardiovascular disease. RECENT FINDINGS In observational prospective studies, higher FGF23 associates with a greater risk of incident cardiovascular disease including ischemic heart disease, stroke, heart failure, and atrial fibrillation. These studies establish a temporal sequence of events over long-term follow-up that suggest a possible role of FGF23 in cardiovascular disease pathogenesis. In most studies, risk is generally graded; however, in the largest study to date, higher FGF23 within the low-normal range was not associated with higher risk. In several recent studies higher FGF23 associated more strongly with the risk of congestive heart failure compared with atherosclerotic events, a finding consistent with surrogate endpoints and animal experiments. Currently, the utility of FGF23 as a predictive biomarker of cardiovascular risk is not established, and interventions to reduce FGF23 need to be studied to confirm its possible pathophysiologic role. SUMMARY Higher FGF23 is associated with the subsequent development of cardiovascular disease, and perhaps most notably heart failure, in a growing number of studies. These findings bolster ongoing efforts to lower FGF23 using strategies to reduce phosphate intake and absorption.
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Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is a well-known risk factor for cardiovascular disease (CVD). Renal biomarkers might be valuable in predicting CVD. Investigation of these biomarkers may uncover some of the poorly understood mechanisms that link renal and CVD as well as aid in the modification of disease and serve as a useful tool in diagnosing early disease and monitoring therapeutic responses. In this review we discuss the clinical utility of emerging and known renal biomarkers in predicting CVD. RECENT FINDINGS Prior to adopting a biomarker into routine clinical practice, evidence-based laboratory medicine requires optimal technical and analytical performance, which is a prerequisite to have confidence in the result. Furthermore, an ideal biomarker should have evidence of its utility in predicting clinical, therapeutic and other health outcomes as well as proving its organizational impact and cost-effectiveness. The renal biomarkers that have been associated with CVD include cystatin C as a better marker of glomerular filtration than creatinine, albuminuria, neutrophil gelatinase associated lipocalin, a marker of acute kidney injury, fibroblast growth factor-23 and parathyroid hormone. Only urine albumin has been adopted into routine clinical practice. SUMMARY Of all the renal biomarkers, only albumin is clearly associated with CVD. The other biomarkers are earlier in clinical development and the evidence base for their clinical utility needs to be expanded substantially before they can be adopted into routine practice.
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Kawai M. The FGF23/Klotho axis in the regulation of mineral and metabolic homeostasis. Horm Mol Biol Clin Investig 2016; 28:55-67. [DOI: 10.1515/hmbci-2015-0068] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/07/2016] [Indexed: 11/15/2022]
Abstract
AbstractThe function of fibroblast growth factor (FGF) 23 has been suggested to be multifaceted beyond its canonical function as a regulator of mineral metabolism. FGF23 was originally shown to play a central role in phosphate (Pi) and vitamin D metabolism, and a number of diseases associated with dysregulated Pi metabolism have been attributed to abnormal FGF23 signaling activities. The discovery of Klotho as a co-receptor for FGF23 signaling has also accelerated understanding on the molecular mechanisms underlying Pi and vitamin D metabolism. In addition to these canonical functions, FGF23 has recently been implicated in a number of metabolic diseases including chronic kidney disease-associated complications, cardiovascular diseases, and obesity-related disorders; however, the physiological significance and molecular mechanisms of these emerging roles of FGF23 remain largely unknown. Molecular and functional insights into the FGF23 pathway will be discussed in the present review, with an emphasis on its role in human disorders related to dysregulated Pi metabolism as well as metabolic disorders.
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Freedman BI, Divers J, Russell GB, Palmer ND, Bowden DW, Carr JJ, Wagenknecht LE, Hightower RC, Xu J, Smith SC, Langefeld CD, Hruska KA, Register TC. Plasma FGF23 and Calcified Atherosclerotic Plaque in African Americans with Type 2 Diabetes Mellitus. Am J Nephrol 2015; 42:391-401. [PMID: 26693712 PMCID: PMC4732898 DOI: 10.1159/000443241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/06/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Fibroblast growth factor 23 (FGF23) is a phosphaturic hormone implicated in disorders of serum phosphorus concentration and vitamin D. The role of FGF23 in vascular calcification remains controversial. METHODS Relationships between FGF23 and coronary artery calcified atherosclerotic plaque (CAC), aortoiliac calcified plaque (CP), carotid artery CP, volumetric bone mineral density (vBMD), albuminuria, and estimated glomerular filtration rate (eGFR) were determined in 545 African Americans with type 2 diabetes (T2D) and preserved kidney function in African American-Diabetes Heart Study participants. Generalized linear models were fitted to test associations between FGF23 and cardiovascular, bone, and renal phenotypes, and change in measurements over time, adjusting for age, gender, African ancestry proportion, body mass index, diabetes duration, hemoglobin A1c, blood pressure, renin-angiotensin-system inhibitors, statins, calcium supplements, serum calcium, and serum phosphate. RESULTS The sample was 56.7% female with a mean (SD) age of 55.6 (9.6) years, diabetes duration of 10.3 (8.2) years, eGFR 90.9 (22.1) ml/min/1.73 m2, urine albumin:creatinine ratio (UACR) 151 (588) (median 13) mg/g, plasma FGF23 161 (157) RU/ml, and CAC 637 (1,179) mg. In fully adjusted models, FGF23 was negatively associated with eGFR (p < 0.0001) and positively associated with UACR (p < 0.0001) and CAC (p = 0.0006), but not with carotid CP or aortic CP. Baseline FGF23 concentration did not associate with changes in vBMD or CAC after a mean of 5.1 years follow-up. CONCLUSIONS Plasma FGF23 concentrations were independently associated with subclinical coronary artery disease, albuminuria, and kidney function in the understudied African American population with T2D. Findings support relationships between FGF23 and vascular calcification, but not between FGF23 and bone mineral density, in African Americans lacking advanced nephropathy.
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Affiliation(s)
- Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Winston-Salem, North Carolina, USA
| | - Jasmin Divers
- Division of Public Health Sciences, Department of Biostatistical Sciences, Center for Public Health Genomics, Winston-Salem, North Carolina, USA
| | - Gregory B. Russell
- Division of Public Health Sciences, Department of Biostatistical Sciences, Center for Public Health Genomics, Winston-Salem, North Carolina, USA
| | - Nicholette D. Palmer
- Department of Biochemistry, Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Winston-Salem, North Carolina, USA
| | - Donald W. Bowden
- Department of Biochemistry, Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Winston-Salem, North Carolina, USA
| | - J. Jeffrey Carr
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lynne E. Wagenknecht
- Division of Public Health Sciences, Department of Biostatistical Sciences, Center for Public Health Genomics, Winston-Salem, North Carolina, USA
| | | | - Jianzhao Xu
- Department of Biochemistry, Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Winston-Salem, North Carolina, USA
| | - S. Carrie Smith
- Department of Internal Medicine, Section on Nephrology, Winston-Salem, North Carolina, USA
| | - Carl D. Langefeld
- Division of Public Health Sciences, Department of Biostatistical Sciences, Center for Public Health Genomics, Winston-Salem, North Carolina, USA
| | - Keith A. Hruska
- Department of Pediatrics, Nephrology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thomas C. Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Fajol A, Chen H, Umbach AT, Quarles LD, Lang F, Föller M. Enhanced FGF23 production in mice expressing PI3K-insensitive GSK3 is normalized by β-blocker treatment. FASEB J 2015; 30:994-1001. [PMID: 26527066 DOI: 10.1096/fj.15-279943] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/28/2015] [Indexed: 12/20/2022]
Abstract
Glycogen synthase kinase (GSK)-3 is a ubiquitously expressed kinase inhibited by insulin-dependent Akt/PKB/SGK. Mice expressing Akt/PKB/SGK-resistant GSK3α/GSK3β (gsk3(KI)) exhibit enhanced sympathetic nervous activity and phosphaturia with decreased bone density. Hormones participating in phosphate homeostasis include fibroblast growth factor (FGF)-23, a bone-derived hormone that inhibits 1,25-dihydroxyvitamin D3 (1,25(OH)2D3; calcitriol) formation and phosphate reabsorption in the kidney and counteracts vascular calcification and aging. FGF23 secretion is stimulated by the sympathetic nervous system. We studied the role of GSK3-controlled sympathetic activity in FGF23 production and phosphate metabolism. Serum FGF23, 1,25(OH)2D3, and urinary vanillylmandelic acid (VMA) were measured by ELISA, and serum and urinary phosphate and calcium were measured by photometry in gsk3(KI) and gsk3(WT) mice, before and after 1 wk of oral treatment with the β-blocker propranolol. Urinary VMA excretion, serum FGF23, and renal phosphate and calcium excretion were significantly higher, and serum 1,25(OH)2D3 and phosphate concentrations were lower in gsk3(KI) mice than in gsk3(WT) mice. Propranolol treatment decreased serum FGF23 and loss of renal calcium and phosphate and increased serum phosphate concentration in gsk3(KI) mice. We conclude that Akt/PKB/SGK-sensitive GSK3 inhibition participates in the regulation of FGF23 release, 1,25(OH)2D3 formation, and thus mineral metabolism, by controlling the activity of the sympathetic nervous system.
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Affiliation(s)
- Abul Fajol
- *Department of Physiology, University of Tübingen, Tübingen, Germany; Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA; and Institute of Agricultural and Nutritional Sciences, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Hong Chen
- *Department of Physiology, University of Tübingen, Tübingen, Germany; Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA; and Institute of Agricultural and Nutritional Sciences, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Anja T Umbach
- *Department of Physiology, University of Tübingen, Tübingen, Germany; Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA; and Institute of Agricultural and Nutritional Sciences, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - L Darryl Quarles
- *Department of Physiology, University of Tübingen, Tübingen, Germany; Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA; and Institute of Agricultural and Nutritional Sciences, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Florian Lang
- *Department of Physiology, University of Tübingen, Tübingen, Germany; Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA; and Institute of Agricultural and Nutritional Sciences, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Michael Föller
- *Department of Physiology, University of Tübingen, Tübingen, Germany; Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA; and Institute of Agricultural and Nutritional Sciences, Martin Luther University of Halle-Wittenberg, Halle, Germany
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Increased FGF23 serum level is associated with unstable carotid plaque in type 2 diabetic subjects with internal carotid stenosis. Cardiovasc Diabetol 2015; 14:139. [PMID: 26459301 PMCID: PMC4603970 DOI: 10.1186/s12933-015-0301-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/01/2015] [Indexed: 12/31/2022] Open
Abstract
Background The object of this study was to investigate the potential role of FGF23 on plaque stability in type 2 diabetic patients with internal carotid artery stenosis. Methods In this retrospective observational study, we analyzed FGF23 serum level in 361 type 2 diabetic patients with internal carotid artery stenosis undergoing carotid endarterectomy and in 598 diabetic controls without carotid atherosclerosis. Results We found that FGF23 median serum levels was significantly higher in patients than in diabetic controls [67.7 (59.5–77.8) pg/mL and 43.89 (37.5–50.4), P < 0.001] and was significantly and independently associated with unstable plaque in patients with internal carotid artery stenosis [OR, 5,71 (95 % CI, 2.09–15.29]. Conclusions We have found, for the first time, that FGF23 could be associated with unstable plaque in type 2 diabetic patients with internal carotid artery stenosis.
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143
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Sinha MD, Turner C, Booth CJ, Waller S, Rasmussen P, Goldsmith DJA, Simpson JM. Relationship of FGF23 to indexed left ventricular mass in children with non-dialysis stages of chronic kidney disease. Pediatr Nephrol 2015; 30:1843-52. [PMID: 25975437 DOI: 10.1007/s00467-015-3125-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 04/13/2015] [Accepted: 04/28/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the association of serum intact fibroblast growth factor 23 (FGF23) concentrations with indexed left ventricular mass in children with non-dialysis stages 3-5 of chronic kidney disease (CKD). METHODS The study cohort comprised 83 children (51 boys; mean age 12.1 ± 3.2 years) with a mean estimated glomerular filtration rate (eGFR) of 32.3 ± 14.6 ml/min/1.73 m(2) who underwent clinic and ambulatory blood pressure measurement (ABPM), echocardiography and evaluation of biochemical markers of CKD-associated mineral bone disease. RESULTS The mean left ventricular mass index (LVMI) was 35.9 ± 8.5 g/m(2.7) (± standard deviation), with 30 (36.1 %) children showing left ventricular hypertrophy (LVH), all eccentric, as defined using age-specific criteria. For all subjects, the mean FGF23 concentration was 142.2 ± 204.4 ng/l and the normalised distribution following log transformation was 1.94 ± 0.39. There was significant univariate correlation of LVMI with GFR, body mass index (BMI) z-score and calcium intake, but not with 24-h systolic ABPM z-score, log intact parathyroid hormone or log FGF23. On multivariate analysis following adjustment for confounders, only elemental calcium content (g/kg/day) estimated from prescribed calcium-based phosphate binder dose (β = 154.9, p < 0.001) and BMI z-score (β = 2.397, p = 0.003) maintained a significant positive relationship with LVMI (model r (2) = 0.225). CONCLUSIONS We observed no significant relationship of FGF23 with LVMI. Larger studies in children are needed to clarify the roles of calcium-containing phosphate binders and FGF23 with LV mass and their roles in the evolution of the development of adverse cardiovascular outcomes.
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Affiliation(s)
- Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Room 64, Sky Level, Westminster Bridge Road, London, SE1 7EH, UK,
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FGF23 in Acute and Chronic Illness. DISEASE MARKERS 2015; 2015:358086. [PMID: 26491212 PMCID: PMC4600945 DOI: 10.1155/2015/358086] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/03/2015] [Accepted: 09/06/2015] [Indexed: 12/31/2022]
Abstract
FGF23 is a bone-derived phosphaturic hormone that may become a useful biomarker for the identification of high-risk patients in chronic but also acute disease. It rises early in chronic kidney disease and is strongly and independently associated with excess morbidity and mortality. Emerging data suggest that FGF23 is also elevated in different scenarios of acute illness. In this review, we give an overview on the role of this interesting disease marker and potential and proven interventional strategies and discuss a blueprint for future research.
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145
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Eser B, Yayar O, Buyukbakkal M, Erdogan B, Ercan Z, Merhametsiz O, haspulat A, Oğuz EG, Dogan İ, Canbakan B, Ayli MD. Fibroblast growth factor is associated to left ventricular mass index, anemia and low values of transferrin saturation. Nefrologia 2015; 35:465-72. [DOI: 10.1016/j.nefro.2015.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 01/09/2023] Open
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The role of bone in CKD-mediated mineral and vascular disease. Pediatr Nephrol 2015; 30:1379-88. [PMID: 25168424 PMCID: PMC6434948 DOI: 10.1007/s00467-014-2919-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/08/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Abstract
Cardiovascular disease is the leading cause of death in pediatric patients with chronic kidney disease (CKD), and vascular calcifications start early in the course of CKD. Based on the growing body of evidence that alterations of bone and mineral metabolism and the therapies designed to treat the skeletal consequences of CKD are linked to cardiovascular calcifications, the Kidney Disease, Improving Global Outcomes (KDIGO) working group redefined renal osteodystrophy as a systemic disorder of mineral and bone metabolism due to CKD, and this newly defined disorder is now known as "chronic kidney disease-mineral bone disorder (CKD-MBD)". Elevated fibroblast growth factor 23 (FGF23), a bone-derived protein, is the first biochemical abnormality to be associated with CKD-MBD, and high FGF23 levels correlate with increased cardiovascular morbidity and mortality, suggesting that bone is central to both initiating and perpetuating the abnormal mineral metabolism and vascular disease in CKD. The current standard therapies for CKD-MBD affect FGF23 levels differently; non-calcium-based binders with or without concurrent use of dietary phosphate restriction reduce FGF23 levels, while calcium-based binders seem to either increase or have no effect on FGF23 levels. Active vitamin D sterols increase FGF23 levels, whereas therapy with calcimimetics decreases FGF23 levels. Thus, the appropriate therapy that will minimize the rise in FGF23 and prevent cardiovascular morbidity remains to be defined.
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Gruson D, Ferracin B, Ahn SA, Zierold C, Blocki F, Hawkins DM, Bonelli F, Rousseau MF. 1,25-Dihydroxyvitamin D to PTH(1-84) Ratios Strongly Predict Cardiovascular Death in Heart Failure. PLoS One 2015; 10:e0135427. [PMID: 26308451 PMCID: PMC4550259 DOI: 10.1371/journal.pone.0135427] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/21/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Vitamin D deficiency and hyperparathyroidism are common in patients with heart failure (HF). There is a growing body of evidence supporting the role of vitamin D and parathyroid hormone (PTH) in cardiac remodeling and worsening of HF. Lack of reliable automated testing of 1,25-dihydroxyvitamin D (1,25(OH)2D), the biologically active metabolite of vitamin D, has limited its contribution to the prognostic assessment of HF. Here, the association of 1,25(OH)2D and PTH(1-84) levels was evaluated for prediction of cardiovascular death in chronic HF patients. METHODS We conducted a single center prospective cohort including 170 chronic HF patients (females n = 36; males n = 134; NYHA II-IV; mean age: 67 years; etiology: ischemic n = 119, dilated cardiomyopathy n = 51; mean LVEF: 23%). The primary outcome was cardiovascular death. RESULTS Serum levels of 1,25(OH)2D decreased markedly with increased HF severity. Medians were 33.3 pg/mL for NYHA-II patients, 23.4 pg/mL for NYHA-III, and 14.0 pg/mL for NYHA-IV patients (p<0.001). Most patients had levels of 25(OH)D below 30ng/mL, and stratification by NYHA functional class did not show significant differences (p = 0.249). The 1,25(OH)2D to PTH(1-84) ratio and the (1,25(OH)2D)2 to PTH(1-84) ratio were found to be the most significantly related to HF severity. After a median follow-up of 4.1 years, 106 out of 170 patients reached the primary endpoint. Cox proportional hazard modeling revealed 1,25(OH)2D and the 1,25(OH)2D to PTH(1-84) ratios to be strongly predictive of outcomes. CONCLUSIONS 1,25(OH)2D and its ratios to PTH(1-84) strongly and independently predict cardiovascular mortality in chronic HF.
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Affiliation(s)
- Damien Gruson
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Benjamin Ferracin
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Sylvie A. Ahn
- Division of Cardiology, Cliniques Universitaires St-Luc and Pôle de recherche cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Claudia Zierold
- DiaSorin Inc, 1951 Northwestern Avenue, Stillwater, Minnesota, 55082, United States of America
| | - Frank Blocki
- DiaSorin Inc, 1951 Northwestern Avenue, Stillwater, Minnesota, 55082, United States of America
| | - Douglas M. Hawkins
- School of Statistics, University of Minnesota, Minneapolis, Minnesota, 55455, United States of America
| | - Fabrizio Bonelli
- DiaSorin Inc, 1951 Northwestern Avenue, Stillwater, Minnesota, 55082, United States of America
| | - Michel F. Rousseau
- Division of Cardiology, Cliniques Universitaires St-Luc and Pôle de recherche cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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148
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Dzgoeva FU, Sopoev MY, Gatagonova TM, Bestaeva TL, Khamitsaeva OV. [Fibroblast growth factor 23 and a novel high-sensitivity troponin I: Early markers and alternative ways of damaging the heart in chronic kidney disease]. TERAPEVT ARKH 2015; 87:68-74. [PMID: 26281199 DOI: 10.17116/terarkh201587668-74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To establish possible pathogenetic relationships between the marker of bone mineral metabolism fibroblast growth factor 23 (FGF-23) and the markers of cardiovascular diseases characterizing the state of cardiomyocytes and that of the vascular wall of the aorta and large vessels in chronic kidney disease (CKD). SUBJECTS AND METHODS A total of 110 patients (57 men and 53 women) aged 25 to 65 years (mean age 56 ± 2.2 years) with different stages of CKD were examined. FGF-23 and troponin I in the sera from all the patients were investigated using enzyme immunoassay kits. Doppler echocardiography was carried out to evaluate the morphofunctional state of the left ventricle (LV). Peak systolic blood flow velocity in the aortic arch and common carotid intima-media thickness were estimated to assess the wall of the aorta and large arteries. RESULTS As renal failure progressed, just at the early CKD stages the patients were found to have elevating FGF-23 and troponin I levels forestalling an increase in parathyroid hormone concentrations and changes in other calcium-phosphorus metabolism indicators. The levels of FGF-23 and the morphofunctional indicators of LV lesion showed a strong direct correlation that preserved its significance in analyzing the factors under study in relation to the function of the kidneys. CONCLUSION The morphogenetic protein FGF-23 seems to play a significant role not only in bone remodeling processes, but also in the development of cardiovascular events in CKD. However, the mechanisms of its implication in the development of heart disease, like the possibilities of using its level changes as early diagnostic criteria for cardiovascular involvement, call for further investigation.
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Affiliation(s)
- F U Dzgoeva
- North Ossetian State Medical Academy, Ministry of Health of Russia, Vladikavkaz, Russia
| | - M Yu Sopoev
- North Ossetian State Medical Academy, Ministry of Health of Russia, Vladikavkaz, Russia; Republican Clinical Hospital, Ministry of Health of the Republic of North Ossetia-Alania, Vladikavkaz
| | - T M Gatagonova
- North Ossetian State Medical Academy, Ministry of Health of Russia, Vladikavkaz, Russia
| | - T L Bestaeva
- North Ossetian State Medical Academy, Ministry of Health of Russia, Vladikavkaz, Russia; Republican Clinical Hospital, Ministry of Health of the Republic of North Ossetia-Alania, Vladikavkaz
| | - O V Khamitsaeva
- North-Caucasian Multidisciplinary Medical Center, Ministry of Health of Russia, Beslan, Russia
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149
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Koller L, Kleber ME, Brandenburg VM, Goliasch G, Richter B, Sulzgruber P, Scharnagl H, Silbernagel G, Grammer TB, Delgado G, Tomaschitz A, Pilz S, Berger R, Mörtl D, Hülsmann M, Pacher R, März W, Niessner A. Fibroblast Growth Factor 23 Is an Independent and Specific Predictor of Mortality in Patients With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail 2015; 8:1059-67. [PMID: 26273098 DOI: 10.1161/circheartfailure.115.002341] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 08/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Strategies to improve risk prediction are of major importance in patients with heart failure (HF). Fibroblast growth factor 23 (FGF-23) is an endocrine regulator of phosphate and vitamin D homeostasis associated with an increased cardiovascular risk. We aimed to assess the prognostic effect of FGF-23 on mortality in HF patients with a particular focus on differences between patients with HF with preserved ejection fraction and patients with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS FGF-23 levels were measured in 980 patients with HF enrolled in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study including 511 patients with HFrEF and 469 patients with HF with preserved ejection fraction and a median follow-up time of 8.6 years. FGF-23 was additionally measured in a second cohort comprising 320 patients with advanced HFrEF. FGF-23 was independently associated with mortality with an adjusted hazard ratio per 1-SD increase of 1.30 (95% confidence interval, 1.14-1.48; P<0.001) in patients with HFrEF, whereas no such association was found in patients with HF with preserved ejection fraction (for interaction, P=0.043). External validation confirmed the significant association with mortality with an adjusted hazard ratio per 1 SD of 1.23 (95% confidence interval, 1.02-1.60; P=0.027). FGF-23 demonstrated an increased discriminatory power for mortality in addition to N-terminal pro-B-type natriuretic peptide (C-statistic: 0.59 versus 0.63) and an improvement in net reclassification index (39.6%; P<0.001). CONCLUSIONS FGF-23 is independently associated with an increased risk of mortality in patients with HFrEF but not in those with HF with preserved ejection fraction, suggesting a different pathophysiologic role for both entities.
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Affiliation(s)
- Lorenz Koller
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Marcus E Kleber
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Vincent M Brandenburg
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Georg Goliasch
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Bernhard Richter
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Patrick Sulzgruber
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Hubert Scharnagl
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Günther Silbernagel
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Tanja B Grammer
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Graciela Delgado
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Andreas Tomaschitz
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Stefan Pilz
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Rudolf Berger
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Deddo Mörtl
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Martin Hülsmann
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Richard Pacher
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Winfried März
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Alexander Niessner
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.).
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Brandenburg VM, Kleber ME, Vervloet MG, Larsson TE, Tomaschitz A, Pilz S, Stojakovic T, Delgado G, Grammer TB, Marx N, März W, Scharnagl H. Soluble klotho and mortality: the Ludwigshafen Risk and Cardiovascular Health Study. Atherosclerosis 2015; 242:483-9. [PMID: 26298739 DOI: 10.1016/j.atherosclerosis.2015.08.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Experimental evidence suggests that soluble klotho (s-klotho), a co-receptor for fibroblast growth factor 23 (FGF23), may modulate cardiovascular risk through multiple mechanisms. However, the predictive value of s-klotho in patients remains unclear. Therefore, the present study examined in a large cohort of patients referred for coronary angiography whether s-klotho is associated with cardiovascular and total mortality. METHODS The longitudinal associations between baseline s-klotho and FGF23 concentrations and mortality were evaluated in 2948 participants of the Ludwigshafen Risk and Cardiovascular Health Study (LURIC), referred for coronary angiography. RESULTS Mean age of participants was: 63 ± 10 years. Patients with diabetes mellitus (n = 1136) had elevated s-klotho: [440 (430-449) versus 414 (406-421) pg/mL, p < 0.001]. S-klotho decreased in parallel to glomerular filtration rate (GFR) and increased in parallel to FGF23. During a median follow-up of 9.9 years, 874 deaths (30%) occurred, 539 (18%) of which were cardiovascular. After adjustment for cardiovascular risk factors, the hazard ratios in the fourth quartile compared to the first quartile of s-klotho were 1.14 (95%CI, 0.94-1.38; p = 0.187) for all-cause mortality and 1.03 (95%CI, 0.80-1.31; p = 0.845) for cardiovascular mortality. Excess mortality prediction by high levels of baseline FGF23 was not modified by adjustment for baseline s-klotho levels. CONCLUSIONS Klotho does not add predictive power to cardiovascular and mortality risk assessment in patients with normal renal function.
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Affiliation(s)
| | - Marcus E Kleber
- Medical Clinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marc G Vervloet
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Tobias E Larsson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Tomaschitz
- Specialist Clinic for Rehabilitation, PV Bad Aussee, Bad Aussee, Austria
| | - Stefan Pilz
- Department of Cardiology, Medical University of Graz, Graz, Austria; Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Graciela Delgado
- Medical Clinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tanja B Grammer
- Medical Clinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nikolaus Marx
- Department of Cardiology, University Hospital of the RWTH Aachen, Germany
| | - Winfried März
- Medical Clinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria; Synlab Academy, Mannheim, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
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