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Kidney Week

Abstract: PO0483

The Association Between Fibroblast Growth Factor 23 (FGF-23) and Pulse Pressure (PP) in CKD Stage G5 Patients

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Rodelo-Haad, Cristian, Instituto Maimonides de Investigacion Biomedica de Cordoba, Cordoba, Andalucía, Spain
  • López-López, Isabel, Hospital Universitario Reina Sofia, Cordoba, Andalucía, Spain
  • Santamaria, Rafael, Instituto Maimonides de Investigacion Biomedica de Cordoba, Cordoba, Andalucía, Spain
  • Munoz-Castaneda, Juan R., Instituto Maimonides de Investigacion Biomedica de Cordoba, Cordoba, Andalucía, Spain
  • Soriano, Sagrario, Instituto Maimonides de Investigacion Biomedica de Cordoba, Cordoba, Andalucía, Spain
  • Rodriguez Portillo, Mariano, Instituto Maimonides de Investigacion Biomedica de Cordoba, Cordoba, Andalucía, Spain
  • Martin-Malo, Alejandro, Instituto Maimonides de Investigacion Biomedica de Cordoba, Cordoba, Andalucía, Spain
Background

FGF23 is associated with increased cardiovascular events and mortality in CKD patients. Non-classical biological effects of FGF23, such as left ventricular hypertrophy and vascular remodeling, may potentially explain this association. Experimental models suggest that FGF23 stimulates renal tubular sodium reabsorption and volume overload. It is plausible that FGF23 also increases blood pressure. The linking of FGF23 increment with blood pressure control may help identify novel risk factors of mortality in CKD patients. Therefore, we aimed to evaluate the relationship between FGF23, blood pressure control, and indirect signs of arterial stiffness in subjects with CKD G5

Methods

Clinical and analytical variables were analyzed in 159 CKD G5 patients immediately before starting kidney replacement therapy. The association between these variables and the levels of intact FGF23 (iFGF23) was evaluated with linear regression models. PP was used as an indirect surrogate of arterial stiffness. Statistics were performed using R v3.6.2

Results

The mean SBP was 158.8±21.3 mmHg, whereas the mean DBP was 87.2±12.3 mmHg, and the mean PP was 76.6±20 mmHg. The median iFGF23 was 468.3 (268.8—904.9) pg/ml. iFGF23 was positively correlated with serum phosphate (p<0.001), plasma sodium (p=0.02), C-reactive protein (p<0.01), SBP (p<0.001), DBP (<0.01) and PP (p=0.02). Linear multivariable analysis (Table1) showed that iFGF23 was independently associated with the increase in SBP, DBP, and PP, suggesting that for each 10 pg/ml increase in iFGF23, the SBP increased 3.7 mmHg, the PAD increased 3.0 mmHg, and PP increased 2.1 mmHg. By every ten years of increment in age, PP increased 2.4 mmHg (p<0.01).

Conclusion

The increase in FGF23 is associated with higher SBP, DBP, and PP. These data suggest that iFGF23 may increase the risk of cardiovascular events in patients with CKD G5 through increasing blood pressure and arterial stiffness.

Table1. Determinants of SBP, DBP, and PP. SBP: Systolic Blood Pressure DBP: Diastolic Blood Pressure. PP: Pulse Pressure. * Model adjusted by serum phosphate, serum calcium, parathyroid hormone, and C-reactive protein