Prognostic Value of Fibroblast Growth Factor 23 in Autosomal Dominant Polycystic Kidney Disease.
Prognostic Value of Fibroblast Growth Factor 23 in Autosomal Dominant Polycystic Kidney Disease.
复制标题
DOI：
10.1016/j.ekir.2021.01.004
复制
发表时间：
2021-04
影响因子：
6
通讯作者：
Yu ASL
中科院分区：
文献类型：
--
作者：
El Ters M;Lu P;Mahnken JD;Stubbs JR;Zhang S;Wallace DP;Grantham JJ;Chapman AB;Torres VE;Harris PC;Bae KT;Landsittel DP;Rahbari-Oskoui FF;Mrug M;Bennett WM;Yu ASL
常染色体显性遗传性多囊肾病（ADPKD）的特征是进行性囊肿生长和功能性肾脏质量丧失，但肾小球滤过率（GFR）下降和终末期肾病（ESRD）的发生在病程后期。因此，非常需要这种疾病的早期预后生物标志物。我们测量了来自PKD放射成像研究联盟（CRISP）队列的192例ADPKD患者的基线血清成纤维细胞生长因子23（FGF 23）水平，这些患者的中位随访时间为13年，并测试了FGF 23水平与身高校正的总肾体积（htTKV）、GFR和至ESRD、死亡、血清肌酐加倍在校正其他协变量（包括htTKV和基因型）后，与最低四分位数相比，基线FGF 23水平最高四分位数的患者htTKV增加率更高（每年0.95%，P = 0.0016），GFR下降率更快（差异为-1.03 ml/min/1.73 m2/年，P = 0.005）。FGF 23的最高四分位数也与ESRD、死亡或血清肌酐加倍的复合终点的风险大幅增加相关（在完全校正的模型中，风险比[HR]为2.45，P = 0.03）。FGF 23是ADPKD疾病进展和临床重要结局的预后生物标志物，对已建立的成像和遗传生物标志物具有附加价值。
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive cyst growth and a loss of functioning renal mass, but a decline in glomerular filtration rate (GFR) and onset of end-stage renal disease (ESRD) occur late in the disease course. There is therefore a great need for early prognostic biomarkers in this disorder. We measured baseline serum fibroblast growth factor 23 (FGF23) levels in 192 patients with ADPKD from the Consortium for Radiologic Imaging Studies of PKD (CRISP) cohort that were followed for a median of 13 years and tested the association between FGF23 levels and change over time in height-adjusted total kidney volume (htTKV), GFR, and time to the composite endpoints of ESRD, death, and doubling of serum creatinine. Patients in the highest quartile for baseline FGF23 level had a higher rate of increase in htTKV (0.95% per year, P = 0.0016), and faster rate of decline in GFR (difference of −1.03 ml/min/1.73 m2 per year, P = 0.005) compared with the lowest quartile, after adjusting for other covariates, including htTKV and genotype. The highest quartile of FGF23 was also associated with a substantial increase in risk for the composite endpoint of ESRD, death, or doubling of serum creatinine (hazard ratio [HR] of 2.45 in the fully adjusted model, P = 0.03). FGF23 is a prognostic biomarker for disease progression and clinically important outcomes in ADPKD, and has additive value to established imaging and genetic biomarkers.