BACKGROUND: A single time-point fibroblast growth factor-23 (FGF23) level is a strong, well-established risk factor for clinical events in chronic kidney disease (CKD). This study investigated whether repeated measurements of FGF23 after 2 years, allowing the calculation of time-averaged FGF23 and the rate of change in FGF23, provided a better prediction of clinical events in CKD than a single time-point value. METHODS: A post-hoc analysis was performed in a subset of 439 adult patients with a median estimated glomerular filtration rate of 36 (interquartile range 28-48) mL/min per 1.73 m(2) of the prospective multicentre MASTERPLAN study, in which paired samples to measure FGF23 were available. The primary outcome was defined as a composite of myocardial infarction, stroke and cardiovascular mortality and secondary end points, which were overall mortality, congestive heart failure (CHF) and start of renal replacement therapy. Only events occurring after Month 24 were included in the analysis. RESULTS: Analysis of different FGF23 measures showed that a single time-point value and time-averaged FGF23 were positively associated with the primary end point, and also with overall mortality, start of renal replacement therapy and CHF. The adjusted hazard ratios of a single value of FGF23 and of time-averaged FGF23 for the composite end points were 1.71 (CI 1.20-2.43) and 1.91 (CI 1.29-2.82), respectively. Change in FGF23 was not associated with any outcome except for the initiation of renal replacement therapy. CONCLUSIONS: Our study confirms that FGF23 is an important cardiovascular risk factor. Two measurements of FGF23 have no added value over a single value to predict the cardiovascular outcome. This study demonstrates that, under routine clinical practice, the variability of FGF23 in 2 years' time is small. Concomitantly, this study showed no benefit of consecutive FGF23 testing for estimating the risk of a clinical event in an individual patient.
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BACKGROUND: A single time-point fibroblast growth factor-23 (FGF23) level is a strong, well-established risk factor for clinical events in chronic kidney disease (CKD). This study investigated whether repeated measurements of FGF23 after 2 years, allowing the calculation of time-averaged FGF23 and the rate of change in FGF23, provided a better prediction of clinical events in CKD than a single time-point value. METHODS: A post-hoc analysis was performed in a subset of 439 adult patients with a median estimated glomerular filtration rate of 36 (interquartile range 28-48) mL/min per 1.73 m(2) of the prospective multicentre MASTERPLAN study, in which paired samples to measure FGF23 were available. The primary outcome was defined as a composite of myocardial infarction, stroke and cardiovascular mortality and secondary end points, which were overall mortality, congestive heart failure (CHF) and start of renal replacement therapy. Only events occurring after Month 24 were included in the analysis. RESULTS: Analysis of different FGF23 measures showed that a single time-point value and time-averaged FGF23 were positively associated with the primary end point, and also with overall mortality, start of renal replacement therapy and CHF. The adjusted hazard ratios of a single value of FGF23 and of time-averaged FGF23 for the composite end points were 1.71 (CI 1.20-2.43) and 1.91 (CI 1.29-2.82), respectively. Change in FGF23 was not associated with any outcome except for the initiation of renal replacement therapy. CONCLUSIONS: Our study confirms that FGF23 is an important cardiovascular risk factor. Two measurements of FGF23 have no added value over a single value to predict the cardiovascular outcome. This study demonstrates that, under routine clinical practice, the variability of FGF23 in 2 years' time is small. Concomitantly, this study showed no benefit of consecutive FGF23 testing for estimating the risk of a clinical event in an individual patient.
Authors: Rupal Mehta; Xuan Cai; Jungwha Lee; Julia J Scialla; Nisha Bansal; James H Sondheimer; Jing Chen; L Lee Hamm; Ana C Ricardo; Sankar D Navaneethan; Rajat Deo; Mahboob Rahman; Harold I Feldman; Alan S Go; Tamara Isakova; Myles Wolf Journal: JAMA Cardiol Date: 2016-08-01 Impact factor: 14.676
Authors: Tamara Isakova; Xuan Cai; Jungwha Lee; Dawei Xie; Xue Wang; Rupal Mehta; Norrina B Allen; Julia J Scialla; Michael J Pencina; Amanda H Anderson; John Talierco; Jing Chen; Michael J Fischer; Susan P Steigerwalt; Mary B Leonard; Chi-Yuan Hsu; Ian H de Boer; John W Kusek; Harold I Feldman; Myles Wolf Journal: J Am Soc Nephrol Date: 2017-11-22 Impact factor: 10.121
Authors: Amarnath Marthi; Killian Donovan; Richard Haynes; David C Wheeler; Colin Baigent; Christopher M Rooney; Martin J Landray; Sharon M Moe; Jun Yang; Lisa Holland; Romina di Giuseppe; Annet Bouma-de Krijger; Borislava Mihaylova; William G Herrington Journal: J Am Soc Nephrol Date: 2018-05-15 Impact factor: 10.121
Authors: Rupal Mehta; Xuan Cai; Jungwha Lee; Dawei Xie; Xue Wang; Julia Scialla; Amanda H Anderson; Jon Taliercio; Mirela Dobre; Jing Chen; Michael Fischer; Mary Leonard; James Lash; Chi-Yuan Hsu; Ian H de Boer; Harold I Feldman; Myles Wolf; Tamara Isakova Journal: Am J Kidney Dis Date: 2019-12-19 Impact factor: 8.860
Authors: David A Drew; Ronit Katz; Stephen Kritchevsky; Joachim H Ix; Michael G Shlipak; Anne B Newman; Andy Hoofnagle; Linda Fried; Mark J Sarnak; Orlando M Gutierrez Journal: Am J Nephrol Date: 2018-04-05 Impact factor: 3.754
Authors: Anneke P Bech; Annet Bouma-de Krijger; Arjan D van Zuilen; Michiel L Bots; Jan A J G van den Brand; Peter J Blankestijn; Jack F M Wetzels; Marc G Vervloet Journal: J Nephrol Date: 2015-02-21 Impact factor: 3.902