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Associations of fibroblast growth factor 23, vitamin D and parathyroid hormone with 5-year outcomes in a prospective primary care cohort of people with chronic kidney disease stage 3

Shardlow, Adam; McIntyre, Natasha J.; Fluck, Richard J.; McIntyre, Christopher W.; Taal, Maarten W.

Associations of fibroblast growth factor 23, vitamin D and parathyroid hormone with 5-year outcomes in a prospective primary care cohort of people with chronic kidney disease stage 3 Thumbnail


Authors

Adam Shardlow

Natasha J. McIntyre

Richard J. Fluck

Christopher W. McIntyre

Maarten W. Taal



Abstract

Objectives Vitamin D deficiency, elevated fibroblast growth factor 23 (FGF23) and elevated parathyroid hormone (PTH) have each been associated with increased mortality in people with chronic kidney disease (CKD). Previous studies have focused on the effects of FGF23 in relatively advanced CKD. This study aims to assess whether FGF23 is similarly a risk factor in people with early CKD, and how this risk compares to that associated with vitamin D deficiency or elevated PTH.

Design Prospective cohort study.

Setting Thirty-two primary care practices.

Participants One thousand six hundred and sixty-four people who met Kidney Disease: Improving Global Outcomes (KDIGO) definitions for CKD stage 3 (two measurements of estimated glomerular filtration rate (eGFR) between 30 and 60?mL/min/1.73 m2 at least 90 days apart) prior to study recruitment.

Outcome measures All-cause mortality over the period of study follow-up and progression of CKD defined as a 25% fall in eGFR and a drop in GFR category, or an increase in albuminuria category.

Results Two hundred and eighty-nine participants died during the follow-up period. Vitamin D deficiency (HR 1.62, 95% CI 1.01 to 2.58) and elevated PTH (HR 1.42, 95%?CI 1.09 to 1.84) were independently associated with all-cause mortality. FGF23 was associated with all-cause mortality in univariable but not multivariable analysis. Fully adjusted multivariable models of CKD progression showed no association with FGF23, vitamin D status or PTH.

Conclusions In this cohort of predominantly older people with CKD stage 3 and low risk of progression, vitamin D deficiency and elevated PTH were independent risk factors for all-cause mortality but elevated FGF23 was not. While FGF23 may have a role as a risk marker in high-risk populations managed in secondary care, our data suggest that it may not be as important in CKD stage 3, managed in primary care.

Citation

Shardlow, A., McIntyre, N. J., Fluck, R. J., McIntyre, C. W., & Taal, M. W. (2017). Associations of fibroblast growth factor 23, vitamin D and parathyroid hormone with 5-year outcomes in a prospective primary care cohort of people with chronic kidney disease stage 3. BMJ Open, 7(8), Article e016528. https://doi.org/10.1136/bmjopen-2017-016528

Journal Article Type Article
Acceptance Date Jun 22, 2017
Online Publication Date Aug 23, 2017
Publication Date Aug 1, 2017
Deposit Date Aug 31, 2017
Publicly Available Date Mar 28, 2024
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 7
Issue 8
Article Number e016528
DOI https://doi.org/10.1136/bmjopen-2017-016528
Public URL https://nottingham-repository.worktribe.com/output/876001
Publisher URL http://bmjopen.bmj.com/content/7/8/e016528

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