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      A study on the association of serum fibroblast growth factor-23 with various indices of chronic kidney disease patients not yet on dialysis

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          Abstract

          Introduction: Fibroblast growth factor-23 (FGF23) is found as a bone derived hormone which can influence the serum levels of parathormone, phosphorous and 1, 25-dihydroxyvitamin D. FGF23 may be a cardiovascular biomarker in patients with chronic kidney disease (CKD). While, FGF23 is inversely correlated with serum adiponectin level, thus it is possible that FGF23 is correlated to fat mass and related to dyslipidemia in CKD.

          Objectives: In this investigation, we studied the association of serum levels of FGF23 with serum lipid profile, body mass index (BMI), and various cardiovascular risk factors in patients with CKD.

          Patients and Methods: This is a cross-sectional study, which was conducted on 80 non-dialysis patients (glomerular filtration rate [GFR] <60 cc/min) with CKD. Laboratory results and demographic information recorded in pre-defined data sheets and their relationship with FGF23 were analyzed.

          Results: Eighty patients were studied. Mean ± standard deviation (SD) of serum creatinine and FGF23 were 2.18 ± 0.73 mg/dl and 15.028 ± 20.20 RU/ml respectively. The correlation between FGF23, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), ApoA, ApoB, intact parathyroid hormone (iPTH), calcium, phosphorous, alkaline phosphatase, 25-hydroxyvitamin D, BMI, waist girth, serum triglyceride and cholesterol was not significant ( P > 0.05). In this study, the correlations of FGF23, with serum albumin ( P = 0.036) and systolic blood pressure ( P = 0.001) were significant.

          Conclusion: Our study showed that there are not any significant correlations among FGF23, BMI and lipid profile. There are not any significant correlations between FGF23 and age, sex, and level of calcium, phosphorous, vitamin D. However, the relationships between FGF23 and serum albumin was negatively significant. Additionally we detected a positive significant correlation of FGF23 with level of systolic blood presure.

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          Identification of a novel fibroblast growth factor, FGF-23, preferentially expressed in the ventrolateral thalamic nucleus of the brain.

          N Itoh, T Yamashita, Paul Yoshioka (2000)
          We isolated mouse cDNA encoding a novel FGF (251 amino acids). As this is the 23rd documented FGF, we termed it FGF-23. FGF-23 has a hydrophobic amino terminus ( approximately 24 amino acids), which is a typical signal sequence. As expected, recombinant mouse FGF-23 was efficiently secreted by High Five insect cell-infected recombinant baculovirus containing the cDNA, indicating that FGF-23 is a secreted protein. We also isolated human cDNA encoding FGF-23 (251 amino acids), which is highly identical ( approximately 72% amino acid identity) to mouse FGF-23. Of human FGF family members, FGF-23 is most similar to FGF-21 and FGF-19 ( approximately 24% and approximately 22% amino acid identities, respectively). Human FGF-23 gene was localized on the chromosome 12p13 and found to be tandem linked (within 5.5 kb) to human FGF-6 gene. The expression of FGF-23 mRNA in mouse adult tissues was examined by real-time quantitative polymerase chain reaction. FGF-23 mRNA was mainly expressed in the brain and thymus at low levels. The localization of FGF-23 mRNA in the brain was examined by in situ hybridization. FGF-23 mRNA in the brain was found to be preferentially expressed in the ventrolateral thalamic nucleus. Therefore, FGF-23 is expected a unique FGF that plays roles in the function of the ventrolateral thalamic nucleus. Copyright 2000 Academic Press.
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            Circulating fibroblast growth factor-23 is associated with vascular dysfunction in the community.

            Majd Mirza, Anders Larsson, Lars Lind … (2009)
            Subjects with chronic kidney disease (CKD) are at higher risk for cardiovascular (CV) disease than the general population. These patients have elevated circulating levels of FGF23, which predict for increased mortality in CKD patients on hemodialysis. Since CV disease is a major cause of death in CKD, we investigated the association between FGF23 and vascular function. We employed a community-based cohort of subjects aged 70, the PIVUS study (n=967), to investigate the relation between serum FGF23, endothelium function and arterial stiffness. Higher FGF23 was weakly associated with both impaired endothelium-dependent (beta=-0.08, p or =90mL/min/1.73m(2) (beta=-0.19 and beta=-0.22, respectively, p<0.001). In addition, higher FGF23 was associated with increased arterial stiffness exclusively in subjects with an age-adjusted impaired renal function (eGFR<60mL/min/1.73m(2)) (beta=0.26, p<0.001). All associations were independent of gender, biochemical covariates and established CV risk factors. Higher serum FGF23 levels, even within the normal range, are independently associated with impaired vasoreactivity and increased arterial stiffness in the community. Additional studies are required to determine possible direct vascular effects of FGF23 and whether FGF23 is a modifiable CV risk factor.
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              Rapid decline of kidney function increases cardiovascular risk in the elderly.

              Michael Shlipak, Ronit Katz, Bryan Kestenbaum … (2009)
              Chronic kidney disease (CKD), defined at a specific time point, is an important risk factor for cardiovascular disease. Whether the rate of kidney function decline contributes additional cardiovascular risk is unknown. In the Cardiovascular Health Study, we compared the associations of changes in kidney function during the first 7 yr with the incidence of heart failure (HF), myocardial infarction (MI), stroke, and peripheral arterial disease (PAD) during the subsequent 8 yr. We defined a rapid decline in cystatin C-based estimated GFR as >3 ml/min per 1.73 m(2)/yr, on the basis of determination at baseline, year 3, and year 7. Among eligible participants, 1083 (24%) had rapid kidney decline. The incidence of each type of cardiovascular event was significantly higher among patients with rapid decline (all P < 0.001). After multivariate adjustment for demographics, cardiovascular disease risk factors, and baseline kidney function, rapid kidney function decline was significantly associated with HF (adjusted hazard ratio [HR] 1.32; 95% confidence interval [CI] 1.13 to 1.53), MI (HR 1.48; 95% CI 1.21 to 1.83), and PAD (HR 1.67; 95% CI 1.02 to 2.75) but not with stroke (HR 1.19; 95% CI 0.97 to 1.45). The association of rapid decline with each outcome did not differ by the presence or absence of CKD. In conclusion, declining kidney function associates with higher risk for HF, MI, and PAD among patients with or without CKD.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Renal Inj Prev
                Journal ID (iso-abbrev): J Renal Inj Prev
                Journal ID (publisher-id): J Renal Inj Prev
                Journal ID (publisher-id): JRIP
                Title: Journal of Renal Injury Prevention
                Publisher: Nickan Research Institute
                ISSN (Electronic): 2345-2781
                Publication date Collection: 2016
                Publication date (Electronic): 22 April 2016
                Volume: 5
                Issue: 2
                Pages: 104-107
                Affiliations
                1Department of Nephrology, Tehran University Medical Sciences, Tehran, Iran
                Author notes
                [* ] Corresponding author: Fatemeh Yaghoubi, yaghoobifatemeh@ 123456yahoo.com
                Article
                DOI: 10.15171/jrip.2016.22
                PMC ID: 4962669
                PubMed ID: 27471744
                SO-VID: 6668e6fa-ef9a-4cff-9fe5-6e03d775b91f
                Copyright © Copyright © 2016 The Author(s); Published by Nickan Research Institute
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 March 2016
                Date accepted : 07 April 2016
                Page count
                Tables: 4, References: 12, Pages: 4
                Categories
                Subject: Original Article

                Keywords: fgf23,chronic kidney disease,dyslipidemia
                Data availability:
                Keywords: fgf23, chronic kidney disease, dyslipidemia

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