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Abstract: PO1794

Longitudinal Changes in FGF-23 and High-Sensitivity C-Reactive Protein with Incident CKD in the Accord-BP Trial

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Liu, Wenjin, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Huang, Yufeng, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Boucher, Robert E., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Chertow, Glenn Matthew, Stanford University, Stanford, California, United States
  • Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

In adults over 50 with increased cardiovascular (CV) risk, intensive systolic blood pressure (SBP) lowering reduces the risk of death and major CV events, but increases the risk of incident CKD. Metabolic manifestations of incident CKD related to intensive SBP lowering are unknown. Here we explored the relation between incident CKD and FGF23, an early marker of bone and mineral metabolism, in participants enrolled in the ACCORD-BP trial.

Methods

We included 362 ACCORD BP participants with incident CKD during follow-up along with 359 control participants without any kidney events. Control participants were matched for age, sex, race/ethnicity, SBP intervention and glycemia intervention arms. Incident CKD was defined as a >30% decrease in eGFR to <60 ml/min/1.73m2. Serum concentrations of FGF23 and hs-CRP were measured using Meso Scale Discovery Immunoassay platform at baseline, month 24 and 48/ close-out. Differences from baseline were estimated for the average of month 24 and 48/ close-out using mixed effect models with fixed effects for group and visit.

Results

Mean age was 63±6 yrs, 55% women, and 30% non-white. Baseline duration of diabetes was 11±8 yrs; baseline eGFR, FGF23 and hsCRP in the incident CKD and control groups were 87±17 and 92±19, 76(55,107) and 52(40,76) pg/ml and 3.2 (1.3,7.2) and 3.8(1.3,12.0) µm/ml, respectively. Longitudinal changes in these parameters are summarized in the Table and Figure.

Conclusion

Compared to controls, incident CKD was associated with increase in serum FGF23 and hsCRP levels. The long-term implications of incident CKD with intensive BP control needs further study.

 Within incident CKDWithin control groupBetween groups differences
 Geometric mean change from baseline (95% CI)
FGF23, pg/ml1.75 (1.67,1.83)0.98 (0.93,1.03)1.79 (1.68,1.91)
hs-CRP, µm/ml0.97 (0.87,1.09)0.70 (0.62,0.79)1.39 (1.20,1.61)
MDRD eGFR0.61 (0.60,0.62)0.90 (0.89,0.92)
0.67 (0.66,0.69)

Funding

  • NIDDK Support