Dataset Information

FGF23 and Left Ventricular Hypertrophy in Children with CKD.

ABSTRACT:

Background and objectives

High plasma concentration of fibroblast growth factor 23 (FGF23) is a risk factor for left ventricular hypertrophy (LVH) in adults with CKD, and induces myocardial hypertrophy in experimental CKD. We hypothesized that high FGF23 levels associate with a higher prevalence of LVH in children with CKD.

Design, setting, participants, & measurements

We performed echocardiograms and measured plasma C-terminal FGF23 concentrations in 587 children with mild-to-moderate CKD enrolled in the Chronic Kidney Disease in Children (CKiD) study. We used linear and logistic regression to analyze the association of plasma FGF23 with left ventricular mass index (LVMI) and LVH (LVMI ?95th percentile), adjusted for demographics, body mass index, eGFR, and CKD-specific factors. We also examined the relationship between FGF23 and LVH by eGFR level.

Results

Median age was 12 years (interquartile range, 8-15) and eGFR was 50 ml/min per 1.73 m² (interquartile range, 38-64). Overall prevalence of LVH was 11%. After adjustment for demographics and body mass index, the odds of having LVH was higher by 2.53 (95% confidence interval, 1.28 to 4.97; P<0.01) in participants with FGF23 concentrations ?170 RU/ml compared with those with FGF23<100 RU/ml, but this association was attenuated after full adjustment. Among participants with eGFR?45 ml/min per 1.73 m², the prevalence of LVH was 5.4%, 11.2%, and 15.3% for those with FGF23 <100 RU/ml, 100-169 RU/ml, and ?170 RU/ml, respectively (P_trend=0.01). When eGFR was ?45 ml/min per 1.73 m², higher FGF23 concentrations were independently associated with LVH (fully adjusted odds ratio, 3.08 in the highest versus lowest FGF23 category; 95% confidence interval, 1.02 to 9.24; P<0.05; fully adjusted odds ratio, 2.02 per doubling of FGF23; 95% confidence interval, 1.29 to 3.17; P<0.01). By contrast, in participants with eGFR<45 ml/min per 1.73 m², FGF23 did not associate with LVH.

Conclusions

Plasma FGF23 concentration ?170 RU/ml is an independent predictor of LVH in children with eGFR?45 ml/min per 1.73 m².

SUBMITTER: Mitsnefes MM

PROVIDER: S-EPMC5753303 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Publications

FGF23 and Left Ventricular Hypertrophy in Children with CKD.

Mitsnefes Mark M MM Betoko Aisha A Schneider Michael F MF Salusky Isidro B IB Wolf Myles Selig MS Jüppner Harald H Warady Bradley A BA Furth Susan L SL Portale Anthony A AA

Clinical journal of the American Society of Nephrology : CJASN 20171012 1

<h4>Background and objectives</h4>High plasma concentration of fibroblast growth factor 23 (FGF23) is a risk factor for left ventricular hypertrophy (LVH) in adults with CKD, and induces myocardial hypertrophy in experimental CKD. We hypothesized that high FGF23 levels associate with a higher prevalence of LVH in children with CKD.<h4>Design, setting, participants, & measurements</h4>We performed echocardiograms and measured plasma C-terminal FGF23 concentrations in 587 children with mild-to-mod ...[more]

PMID: 29025789

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Project description:Background and objectivesIn children with CKD, information is limited regarding the prevalence and determinants of fibroblast growth factor 23 excess and 1,25-dihyroxyvitamin D deficiency across the spectrum of predialysis CKD. This study characterized circulating concentrations of fibroblast growth factor 23 and 1,25-dihyroxyvitamin D, and investigated their interrelationships and associations with GFR and secondary hyperparathyroidism in children with CKD who were enrolled in the Chronic Kidney Disease in Children observational cohort study.Design, setting, participants, & measurementsPlasma fibroblast growth factor 23 concentrations and determinants of mineral metabolism were measured in 464 children ages 1-16 years with predialysis CKD. GFR was measured by plasma disappearance of iohexol in 70% of participants and estimated by the Chronic Kidney Disease in Children estimating equation using serum creatinine and cystatin C concentrations in the remainder of the participants. Participants were grouped according to CKD stage and by 10-ml/min categories of GFR.ResultsMedian GFR for the cohort was 45 ml/min per 1.73 m(2) (interquartile range=33-57; range=15-109). Plasma fibroblast growth factor 23 concentration was above the normal range in 67% of participants (with higher levels observed among participants with lower GFR) before higher levels of serum parathyroid hormone and phosphorus were observed. Plasma fibroblast growth factor 23 levels were 34% higher in participants with glomerular disease than in participants with nonglomerular disease, despite similar GFR. Serum phosphorus levels, adjusted for age, were significantly lower at GFR of 60-69 ml/min per 1.73 m(2) than higher GFR, but thereafter they became higher in parallel with fibroblast growth factor 23 as GFR declined. Serum 1,25-dihyroxyvitamin D concentrations were lower in those participants with low GFR values, high fibroblast growth factor 23 levels, 25-hydroxyvitamin D deficiency, and proteinuria. Secondary hyperparathyroidism was present in 55% of participants with GFR<50 ml/min per 1.73 m(2).ConclusionIn children with predialysis CKD, high plasma fibroblast growth factor 23 is the earliest detectable abnormality in mineral metabolism, and levels are highest in glomerular diseases.

Dataset Information

FGF23 and Left Ventricular Hypertrophy in Children with CKD.

Background and objectives

Design, setting, participants, & measurements

Results

Conclusions

Publications

FGF23 and Left Ventricular Hypertrophy in Children with CKD.

Similar Datasets

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