Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease.
Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease.
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DOI：
10.1001/jama.2011.826
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发表时间：
2011-06-15
影响因子：
120.7
通讯作者：
Wolf, Myles
中科院分区：
文献类型：
--
作者：
Isakova, Tamara;Xie, Huiliang;Yang, Wei;Xie, Dawei;Anderson, Amanda Hyre;Scialla, Julia;Wahl, Patricia;Gutierrez, Orlando M.;Steigerwalt, Susan;He, Jiang;Schwartz, Stanley;Lo, Joan;Ojo, Akinlolu;Sondheimer, James;Hsu, Chi-yuan;Lash, James;Leonard, Mary;Kusek, John W.;Feldman, Harold I.;Wolf, Myles
高水平的磷酸盐调节激素，成纤维细胞生长因子23（FGF 23），与终末期肾病（ESRD）患者的死亡率相关，但在更大的慢性肾病（CKD）早期患者人群中，其与不良结局的关系知之甚少。评估FGF 23作为CKD患者不良结局的风险因素。一项前瞻性研究，纳入了2003年6月至2008年9月期间入组慢性肾功能不全队列的3，879例CKD 2 - 4期受试者。全因死亡率和ESRD。入组时，平均估计肾小球滤过率（eGFR）为42.8 ± 13.5 ml/min/1.73 m2，中位FGF 23为145（四分位距[IQR] 96 - 239）参考单位/ml（RU/ml）。在中位3.5（IQR 2.5 - 4.4）年的随访期间，266名参与者死亡（20.3/1000人年），410名参与者达到ESRD（33.0/1000人年）。在连续量表的FGF 23校正分析中，较高的FGF 23水平与较高的死亡风险独立相关（风险比[HR]/lnFGF 23的SD，1.5; 95%CI 1.3 - 1.7）或四分位数（四分位数1，参考;四分位数2，HR 1.3; 95%CI 0.8 - 2.2;四分位数3，HR 2.0; 95%CI 1.2 - 3.3;四分位数4，HR 3.0; 95%CI 1.8 - 5.1）。在整个队列的校正分析中，FGF 23与ESRD无关，然而，eGFR（相互作用P = 0.005）修正了该效应，eGFR是ESRD的最强预测因子。在eGFR为30 - 44（HR 1.3/lnFGF 23 SD; 95%CI 1.04 - 1.6）和≥ 45（HR 1.7; 95%CI 1.1 - 2.4）的参与者中，FGF 23独立与ESRD风险显著增加相关，但与< 30 ml/min/1.73m2无关。FGF 23升高是肾功能相对保留的患者中ESRD的独立风险因素，也是CKD患者死亡率的独立风险因素。
High levels of the phosphate regulating hormone, fibroblast growth factor 23 (FGF23), associate with mortality in patients with end-stage renal disease (ESRD), but little is known about its relationship with adverse outcomes in the much larger population of patients with earlier stages of chronic kidney disease (CKD). Evaluate FGF23 as a risk factor for adverse outcomes in patients with CKD. A prospective study of 3,879 participants with CKD stages 2 – 4 who enrolled in the Chronic Renal Insufficiency Cohort between June 2003 and September 2008. All-cause mortality and ESRD. At enrollment, mean estimated glomerular filtration rate (eGFR) was 42.8 ± 13.5 ml/min/1.73m2, and median FGF23 was 145 (interquartile range [IQR] 96 – 239) reference units/ml (RU/ml). During a median follow-up of 3.5 (IQR 2.5 – 4.4) years, 266 participants died (20.3/1000 person-years) and 410 reached ESRD (33.0/1000 person-years). Higher FGF23 levels independently associated with a greater risk of death in adjusted analyses of FGF23 on a continuous scale (hazard ratio [HR] per SD of lnFGF23, 1.5; 95%CI 1.3 – 1.7) or in quartiles (quartile 1, reference; quartile 2, HR 1.3; 95%CI 0.8 – 2.2; quartile 3, HR 2.0; 95%CI 1.2 – 3.3; quartile 4, HR 3.0; 95%CI 1.8 – 5.1). FGF23 was not independently associated with ESRD in adjusted analyses of the entire cohort, however, the effect was modified by eGFR (P for interaction = 0.005), which was the strongest predictor for ESRD. FGF23 independently associated with significantly greater risk of ESRD among participants with eGFR 30 – 44 (HR 1.3 per SD of lnFGF23; 95%CI 1.04 – 1.6) and ≥ 45 (HR 1.7; 95%CI 1.1 – 2.4), but not < 30 ml/min/1.73m2. Elevated FGF23 is an independent risk factor for ESRD in patients with relatively preserved kidney function and for mortality across the spectrum of CKD.
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DOI：
10.2215/cjn.05420709
发表时间：
2010-02-01
影响因子：
9.8
作者：
Oliveira, Rodrigo B.;Cancela, Ana L. E.;Moyses, Rosa M. A.
通讯作者：
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DOI：
10.1056/nejmoa0706130
发表时间：
2008-08-07
期刊：
The New England journal of medicine
影响因子：
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作者：
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通讯作者：
Wolf M
影响因子：
13.6
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Isakova, Tamara;Gutierrez, Orlando M.;Wolf, Myles
通讯作者：
Wolf, Myles
影响因子：
6.1
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影响因子：
6.1
作者：
Mirza, Majd A. I.;Hansen, Tomas;Larsson, Tobias E.
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