Association between fibroblast growth factor 23 and cardiovascular risk factors in predialytic chronic kidney disease patients

ABSTRACT Introduction: Fibroblast growth factor 23 (FGF-23) is found to be involved in the pathogenesis of both kidney and cardiovascular disease (CVD). We evaluated the relationship between FGF-23, cardiovascular risk factors, and carotid intimamedia thickness (CIMT) in chronic kidney disease (CKD) (pre-dialysis) patients. Methods: This is a twoyear crosssectional study involving 75 patients with CKD from stage one to stage five attending the nephrology outpatient department and 25 healthy controls. Routine biochemical parameters were analyzed on a clinical chemistry autoanalyzer (Beckman Coulter DXC 600 Synchron, USA). FGF-23 was estimated by the enzyme-linked immunosorbent assay (ELISA) method. Carotid intimamedia wall thickness was estimated by Doppler for carotid vessels. Results: There was a significant increase in the serum FGF-23 level with the progression of CKD. Other non-traditional cardiovascular risk factors such as CIMT, interleukin 6, fibrinogen, and homocysteine were significantly increased in patients for CKD compared to controls. FGF-23, interleukin 6, fibrinogen, CIMT, parathyroid hormone, and homocysteine progressively increased from the early stages of CKD and increased further with the progression of the disease, but nitric oxide (NO) levels progressively decreased with the progression of CKD. Interleukin 6 showed a positive correlation with CIMT, interleukin 6, fibrinogen, and homocysteine and a negative correlation with estimated glomerular filtration rate and NO. There was a close, direct association between circulating levels of FGF-23 and the presence of atherosclerotic plaques in the carotid arteries of patients with CKD. Conclusion: FGF-23 and nontraditional CVD risk factors are altered in the early stages of CKD and might predict adverse outcomes in these patients.