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Abstract: PO0343

Fibroblast Growth Factor 23 (FGF-23), Calcification Propensity, and Heart Failure with Preserved Ejection Fraction (HFpEF) in Patients with CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Leidner, Alexander S., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Cai, Xuan, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Zelnick, Leila R., University of Washington, Seattle, Washington, United States
  • Bansal, Nisha, University of Washington, Seattle, Washington, United States
  • Pasch, Andreas, Calcison, Bern, Switzerland
  • Kansal, Mayank, University of Illinois at Chicago, Chicago, Illinois, United States
  • Chen, Jing, Tulane University, New Orleans, Louisiana, United States
  • Anderson, Amanda Hyre, Tulane University, New Orleans, Louisiana, United States
  • Sondheimer, James H., Wayne State University, Detroit, Michigan, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
  • Townsend, Raymond R., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Go, Alan S., Kaiser Permanente, Oakland, California, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Wolf, Myles, Duke University School of Medicine, Durham, North Carolina, United States
  • Isakova, Tamara, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Mehta, Rupal, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
Background

HFpEF represents half of all HF events and is common in patients with CKD. Given lack of treatments, identifying factors that impact HFpEF development is critical. FGF23 is an osteocyte-derived hormone involved in phosphorous homeostasis and is implicated in HF development. Calcification propensity (T50) is an in vitro assessment of the time for secondary calciprotein particle formation.

Methods

Using multivariable adjusted Cox proportional hazards models, we investigated the associations of FGF23 and T50 with incident HFpEF. FGF23 and T50 were measured at the baseline and Year 1 visits, respectively. Incident HFpEF was defined as ejection fraction > 50% on echocardiogram at the time of event or by a CRIC Study echocardiogram within 1 year. After excluding individuals with baseline HF and individuals with HF events prior to analyte measurement, we included 3502 and 3029 individuals for our FGF23 and T50 analyses, respectively.

Results

In the FGF23 cohort, 333 incident HFpEF events occurred over a median follow-up of 10.8 years. In the T50 cohort, 259 incident HFpEF events occurred over a median follow-up of 10.2 years. Individuals in the highest FGF23 and lowest T50 quartiles had the highest rates of incident HFpEF (Figure). When adjusted for demographics, cardiovascular risk factors and kidney function, elevated FGF23, but not T50, was independently associated with incident HFpEF (Table).

Conclusion

FGF23, but not T50, was associated with incident HFpEF in patients with CKD. These data are consistent with studies demonstrating cardiac toxicity of FGF23 and may inform future trials of HFpEF development in CKD.

Funding

  • NIDDK Support