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Abstract: PO0346

Association of Changes in Levels of eGFR and Fibroblast Growth Factor 23 from Midlife to Late Life with Risk of Mortality: The ARIC Study

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Ishigami, Junichi, Johns Hopkins University, Baltimore, Maryland, United States
  • Honda, Yasuyuki, Johns Hopkins University, Baltimore, Maryland, United States
  • Karger, Amy B., University of Minnesota, Minneapolis, Minnesota, United States
  • Selvin, Elizabeth, Johns Hopkins University, Baltimore, Maryland, United States
  • Coresh, Josef, Johns Hopkins University, Baltimore, Maryland, United States
  • Lutsey, Pamela L., University of Minnesota, Minneapolis, Minnesota, United States
  • Matsushita, Kunihiro, Johns Hopkins University, Baltimore, Maryland, United States
Background

Aging from midlife to late-life involves the dynamics of levels of eGFR and fibroblast growth factor 23 (FGF23). Whether changes in levels of eGFR and FGF23 from midlife to late-life are independently and jointly associated with subsequent risk of mortality is unknown.

Methods

We included 5639 participants of the Atherosclerosis Risk in Communities Study who had eGFR and serum level of FGF23 measured during midlife (visit 3, 1993-1995, mean age 58 [SD, 5] years, 58% women, 23% black race) and late-life (visit 5, 2011-2013, mean age 76 years). We used Cox regression to examine the associations of past changes in levels of eGFR and FGF23 levels (in quartiles)-- separately and jointly--with mortality from visit 5 (2011-2013) through December 31, 2017.

Results

The median eGFR 15-year decline (from visit 3 to 5) was 20.5 ml/min/1.73m2 (from median eGFRs 87.8 to 65.7 ml/min/1.73m2). The median FGF23 increase was 17.4 pg/mL (median FGF23s 37.5 to 54.8 pg/mL). During a median follow-up of 5.5 years after visit 5, 868 participants died. Adjusted HRs of mortality were 1.93 (95%CI, 1.59-2.34) for the highest quartile for eGFR decline, and 1.69 (1.40-2.04) for the highest quartile for FGF23 increase compared the lowest quartile (Figure A). When assessing in the cross-category of eGFR and FGF23 changes, the risk was highest for the highest quartiles of eGFR decline and FGF23 increase (HR, 2.09 [1.74-2.50]; Figure B).

Conclusion

In this community-based cohort, greater eGFR decline and FGF23 increase from midlife to late-life were independently associated with a higher risk of mortality, with the risk highest when eGFR decline was accompanied by FGF23 increase.