ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2019
Single Measurements of Carboxy-Terminal Fibroblast Growth Factor 23 and Clinical Risk Prediction of Adverse Outcomes in CKD.
Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The bidirectional association between obstructive sleep apnea and diabetic kidney disease: systematic review and meta-analysis.Frontiers in endocrinology · 2025Pooled it
- Representation of multimorbidity and frailty in the development and validation of kidney failure prognostic prediction models: a systematic review.BMC medicine · 2024Pooled it
- Improved cardiovascular risk prediction in patients with end-stage renal disease on hemodialysis using machine learning modeling and circulating microribonucleic acids.Theranostics · 2020Trial
- C-terminal FGF-23 production coupling with aldosterone via FAM20C and predicting cardiovascular events in primary aldosteronism.JCI insight · 2025Article
- Baseline intact fibroblast growth factor 23 and risk of kidney disease progression in the Indian Chronic Kidney Disease cohort: a prospective multicenter study.Frontiers in medicine · 2025Article
- Klotho and Clinical Outcomes in CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2024Observational
- Impact of inflammatory markers on the relationship between sleep quality and diabetic kidney disease.Sleep & breathing = Schlaf & Atmung · 2022Article
- Regulation of FGF23: Beyond Bone.Current osteoporosis reports · 2021Review
- Inflammation: a putative link between phosphate metabolism and cardiovascular disease.Clinical science (London, England : 1979) · 2021Review
- Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Chronic Kidney Disease-A Pediatric Perspective.Frontiers in pediatrics · 2021Review
- Association between albumin-to-globulin ratio and long-term mortality in patients with chronic kidney disease: a cohort study.International urology and nephrology · 2020Article
- Fibroblast growth factor 23: are we ready to use it in clinical practice?Journal of nephrology · 2020Review
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Authors and funding
15 authors.
Funding
Abstract
RATIONALE &
objectiveAn elevated fibroblast growth factor 23 (FGF-23) level is independently associated with adverse outcomes in populations with chronic kidney disease, but it is unknown whether FGF-23 testing can improve clinical risk prediction in individuals. STUDY
designProspective cohort study. SETTING &
participantsParticipants in the Chronic Renal Insufficiency Cohort (CRIC) Study (n = 3,789). EXPOSURE: Baseline carboxy-terminal FGF-23 (cFGF-23) level. OUTCOMES: All-cause and cardiovascular (CV) mortality, incident end-stage renal disease (ESRD), heart failure (HF) admission, and atherosclerotic events at 3, 5, and 8 years. ANALYTICAL APPROACH: We assessed changes in model performance by change in area under the receiver operating characteristic curve (ΔAUC), integrated discrimination improvement (IDI), relative IDI, and net reclassification index (NRI) above standard clinical factors. We performed sensitivity analyses, including an additional model comparing the addition of phosphate rather than cFGF-23 level and repeating our analyses using an internal cross-validation cohort.
resultsAddition of a single baseline value of cFGF-23 to a base prediction model improved prediction of all-cause mortality (ΔAUC, 0.017 [95% CI, 0.001-0.033]; IDI, 0.021 [95% CI, 0.006-0.036]; relative IDI, 32.7% [95% CI, 8.5%-56.9%]), and HF admission (ΔAUC, 0.008 [95% CI, 0.0004-0.016]; IDI, 0.019 [95% CI, 0.004-0.034]; relative IDI, 10.0% [95% CI, 1.8%-18.3%]), but not CV mortality, ESRD, or atherosclerotic events at 3 years of follow-up. The NRI did not reach statistical significance for any of the 3-year outcomes. The incremental predictive utility of cFGF-23 level diminished in analyses of the 5- and 8-year outcomes. The cFGF-23 models outperformed the phosphate model for each outcome. LIMITATIONS: Power to detect increased CV mortality likely limited by low event rate. The NRI is not generalizable without accepted prespecified risk thresholds.
conclusionsAmong individuals with CKD, single measurements of cFGF-23 improve prediction of risks for all-cause mortality and HF admission but not CV mortality, ESRD, or atherosclerotic events. Future studies should evaluate the predictive utility of repeated cFGF-23 testing.
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