TY - JOUR
T1 - Fibroblast growth factor 23 and anemia in the chronic renal insufficiency cohort study
AU - CRIC Study Investigators
AU - Mehta, Rupal
AU - Cai, Xuan
AU - Hodakowski, Alexander
AU - Lee, Jungwha
AU - Leonard, Mary
AU - Ricardo, Ana
AU - Chen, Jing
AU - Hamm, Lee
AU - Sondheimer, James
AU - Dobre, Mirela
AU - David, Valentin
AU - Yang, Wei
AU - Go, Alan
AU - Kusek, John W.
AU - Feldman, Harold
AU - Wolf, Myles
AU - Isakova, Tamara
N1 - Publisher Copyright:
© 2017 by the American Society of Nephrology.
PY - 2017/11/7
Y1 - 2017/11/7
N2 - Background and objectives Anemia is an early complication of CKD that is associated with increased morbidity and mortality. Prior data show associations between abnormal mineral metabolism markers and decreased erythropoiesis. However, few studies have investigated elevated fibroblast growth factor 23 as a risk factor for the development of anemia in patients with CKD. Design, setting, participants, & measurements We conducted a prospective cohort study of 3869 individuals with mild to severe CKD enrolled in the Chronic Renal Insufficiency Cohort Study between 2003 and 2008 and followed through 2013. We hypothesized that elevated baseline fibroblast growth factor 23 levels are associated with prevalent anemia, decline in hemoglobin over time, and development of incident anemia, defined as serum hemoglobin level <13 g/dl in men, serum hemoglobin level <12 g/dl in women, or use of erythropoietin stimulating agents. Results In the 1872 of 3869 individuals who had prevalent anemia at baseline, mean age was 58 (11) years old, and mean eGFR was 39 (13) ml/min per 1.73 m2. Higher levels of fibroblast growth factor 23 were significantly associated with prevalent anemia (odds ratioper 1-SD increase innatural log–transformedfibroblast growth factor 23, 1.39; 95% confidence interval, 1.26 to 1.52), decline in hemoglobin over 4 years, and risk of incident anemia (hazard ratio per 1-SD increase in natural log–transformed fibroblast growth factor 23, 1.13; 95% confidence interval, 1.04 to 1.24; quartile 4 versus quartile 1: hazard ratio, 1.59; 95% confidence interval, 1.19 to 2.11) independent of demographic characteristics, cardiovascular disease risk factors, CKD-specific factors, and other mineral metabolism markers. The results of our prospective analyses remained unchanged after additional adjustment for time-varying eGFR. Conclusions Elevated fibroblast growth factor 23 is associated with prevalent anemia, change in hemoglobin over time, and development of anemia. Future studies are needed to elucidate the mechanisms for these associations.
AB - Background and objectives Anemia is an early complication of CKD that is associated with increased morbidity and mortality. Prior data show associations between abnormal mineral metabolism markers and decreased erythropoiesis. However, few studies have investigated elevated fibroblast growth factor 23 as a risk factor for the development of anemia in patients with CKD. Design, setting, participants, & measurements We conducted a prospective cohort study of 3869 individuals with mild to severe CKD enrolled in the Chronic Renal Insufficiency Cohort Study between 2003 and 2008 and followed through 2013. We hypothesized that elevated baseline fibroblast growth factor 23 levels are associated with prevalent anemia, decline in hemoglobin over time, and development of incident anemia, defined as serum hemoglobin level <13 g/dl in men, serum hemoglobin level <12 g/dl in women, or use of erythropoietin stimulating agents. Results In the 1872 of 3869 individuals who had prevalent anemia at baseline, mean age was 58 (11) years old, and mean eGFR was 39 (13) ml/min per 1.73 m2. Higher levels of fibroblast growth factor 23 were significantly associated with prevalent anemia (odds ratioper 1-SD increase innatural log–transformedfibroblast growth factor 23, 1.39; 95% confidence interval, 1.26 to 1.52), decline in hemoglobin over 4 years, and risk of incident anemia (hazard ratio per 1-SD increase in natural log–transformed fibroblast growth factor 23, 1.13; 95% confidence interval, 1.04 to 1.24; quartile 4 versus quartile 1: hazard ratio, 1.59; 95% confidence interval, 1.19 to 2.11) independent of demographic characteristics, cardiovascular disease risk factors, CKD-specific factors, and other mineral metabolism markers. The results of our prospective analyses remained unchanged after additional adjustment for time-varying eGFR. Conclusions Elevated fibroblast growth factor 23 is associated with prevalent anemia, change in hemoglobin over time, and development of anemia. Future studies are needed to elucidate the mechanisms for these associations.
KW - Anemia
KW - Cardiovascular diseases
KW - Chronic
KW - Confidence intervals
KW - Demography
KW - Erythropoiesis
KW - Erythropoietin
KW - Female
KW - Fibroblast growth factors
KW - Glomerular filtration rate
KW - Hemoglobins
KW - Humans
KW - Male
KW - Mineral metabolism
KW - Minerals
KW - Odds ratio
KW - Prospective studies
KW - Renal insufficiency
KW - Risk factors
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U2 - 10.2215/CJN.03950417
DO - 10.2215/CJN.03950417
M3 - Article
C2 - 28784656
AN - SCOPUS:85033395412
SN - 1555-9041
VL - 12
SP - 1795
EP - 1803
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 11
ER -
