Anna Jovanovich1,2, Charles Ginsberg3, Zhiying You2, Ronit Katz4, Walter T Ambrosius5, Dan Berlowitz6, Alfred K Cheung7,8, Monique Cho8, Alexandra K Lee9, Henry Punzi10, Shakaib Rehman11,12, Christianne Roumie13, Mark A Supiano7,8, Clinton B Wright14, Michael Shlipak9, Joachim H Ix3,15, Michel Chonchol2. 1. VA Eastern Colorado Healthcare System, Aurora, Colorado. 2. University of Colorado Anschutz Medical Campus, Aurora, Colorado. 3. University of California San Diego, San Diego, California. 4. University of Washington, Seattle, Washington. 5. Wake Forest School of Medicine, Winston-Salem, North Carolina. 6. Boston University, Boston, Massachusetts. 7. University of Utah, Salt Lake City, Utah. 8. Salt Lake City VA Medical Center, Salt Lake City, Utah. 9. University of California, San Francisco, San Francisco, California. 10. Punzi Medical Center, Carrollton, Texas. 11. Phoenix VA Healthcare System, Phoenix, Arizona. 12. University of Arizona College of Medicine-Phoenix, Phoenix, Arizona. 13. Vanderbilt University, Nashville, Tennessee. 14. National Institute of Neurological Disorders and Stroke, Bethesda, Maryland. 15. Veterans Affairs San Diego Healthcare System, San Diego, California.
Abstract
BACKGROUND/ OBJECTIVES: Chronic kidney disease (CKD) is associated with frailty. Fibroblast growth factor 23 (FGF23) is elevated in CKD and associated with frailty among non-CKD older adults and individuals with human immunodeficiency virus. Whether FGF23 is associated with frailty and falls in CKD is unknown. DESIGN: Cross-sectional and longitudinal observational study. SETTING: Systolic Blood Pressure Intervention Trial (SPRINT), a randomized trial evaluating standard (systolic blood pressure [SBP] <140 mm Hg) versus intensive (SBP <120 mm Hg) blood pressure lowering on cardiovascular and cognitive outcomes among older adults without diabetes mellitus. PARTICIPANTS: A total of 2,376 participants with CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 ). MEASUREMENTS: The exposure variable was intact FGF23. We used multinomial logistic regression to determine the cross-sectional association of intact FGF23 with frailty and Cox proportional hazards analysis to determine the longitudinal association with incident falls. Models were adjusted for demographics, comorbidities, randomization group, antihypertensives, eGFR, mineral metabolism markers, and frailty. RESULTS: After adjustment, the odds ratio for prevalent frailty versus non-frailty per twofold higher FGF23 was 1.34 (95% confidence interval [CI] = 1.01-1.77). FGF23 levels in the highest quartile versus the lowest quartile demonstrated more than a twofold increased fall risk (hazard ratio [HR] = 2.32; 95% CI = 1.26-4.26), and the HR per twofold higher FGF23 was 1.99 (95% CI = 1.48-2.68). CONCLUSION: Among SPRINT participants with CKD, FGF23 was associated with prevalent frailty and falls.
BACKGROUND/ OBJECTIVES: Chronic kidney disease (CKD) is associated with frailty. Fibroblast growth factor 23 (FGF23) is elevated in CKD and associated with frailty among non-CKD older adults and individuals with human immunodeficiency virus. Whether FGF23 is associated with frailty and falls in CKD is unknown. DESIGN: Cross-sectional and longitudinal observational study. SETTING: Systolic Blood Pressure Intervention Trial (SPRINT), a randomized trial evaluating standard (systolic blood pressure [SBP] <140 mm Hg) versus intensive (SBP <120 mm Hg) blood pressure lowering on cardiovascular and cognitive outcomes among older adults without diabetes mellitus. PARTICIPANTS: A total of 2,376 participants with CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 ). MEASUREMENTS: The exposure variable was intact FGF23. We used multinomial logistic regression to determine the cross-sectional association of intact FGF23 with frailty and Cox proportional hazards analysis to determine the longitudinal association with incident falls. Models were adjusted for demographics, comorbidities, randomization group, antihypertensives, eGFR, mineral metabolism markers, and frailty. RESULTS: After adjustment, the odds ratio for prevalent frailty versus non-frailty per twofold higher FGF23 was 1.34 (95% confidence interval [CI] = 1.01-1.77). FGF23 levels in the highest quartile versus the lowest quartile demonstrated more than a twofold increased fall risk (hazard ratio [HR] = 2.32; 95% CI = 1.26-4.26), and the HR per twofold higher FGF23 was 1.99 (95% CI = 1.48-2.68). CONCLUSION: Among SPRINT participants with CKD, FGF23 was associated with prevalent frailty and falls.
Authors: Candace L Crasto; Richard D Semba; Kai Sun; Anne R Cappola; Stefania Bandinelli; Luigi Ferrucci Journal: Rejuvenation Res Date: 2012-04-24 Impact factor: 4.663
Authors: Julia J Scialla; Huiliang Xie; Mahboob Rahman; Amanda Hyre Anderson; Tamara Isakova; Akinlolu Ojo; Xiaoming Zhang; Lisa Nessel; Takayuki Hamano; Juan E Grunwald; Dominic S Raj; Wei Yang; Jiang He; James P Lash; Alan S Go; John W Kusek; Harold Feldman; Myles Wolf Journal: J Am Soc Nephrol Date: 2013-10-24 Impact factor: 10.121
Authors: Matteo Cesari; Brenda W J H Penninx; Marco Pahor; Fulvio Lauretani; Anna Maria Corsi; G Rhys Williams; Jack M Guralnik; Luigi Ferrucci Journal: J Gerontol A Biol Sci Med Sci Date: 2004-03 Impact factor: 6.053