Fibroblast growth factor 23 is not associated with and does not induce arterial calcification

Julia J. Scialla, Wei Ling Lau, Muredach P. Reilly, Tamara Isakova, Hsueh Ying Yang, Matthew H. Crouthamel, Nicholas W. Chavkin, Mahboob Rahman, Patricia Wahl, Ansel P. Amaral, Takayuki Hamano, Stephen R. Master, Lisa Nessel, Boyang Chai, Dawei Xie, Radhakrishna R. Kallem, Jing Chen, James P. Lash, John W. Kusek, Matthew J. BudoffCecilia M. Giachelli, Myles Wolf

Research output: Contribution to journalArticlepeer-review

230 Scopus citations


Elevated fibroblast growth factor 23 (FGF23) is associated with cardiovascular disease in patients with chronic kidney disease. As a potential mediating mechanism, FGF23 induces left ventricular hypertrophy; however, its role in arterial calcification is less clear. In order to study this, we quantified coronary artery and thoracic aorta calcium by computed tomography in 1501 patients from the Chronic Renal Insufficiency Cohort (CRIC) study within a median of 376 days (interquartile range 331-420 days) of baseline. Baseline plasma FGF23 was not associated with the prevalence or severity of coronary artery calcium after multivariable adjustment. In contrast, higher serum phosphate levels were associated with prevalence and severity of coronary artery calcium, even after adjustment for FGF23. Neither FGF23 nor serum phosphate were consistently associated with thoracic aorta calcium. We could not detect mRNA expression of FGF23 or its coreceptor, klotho, in human or mouse vascular smooth muscle cells, or normal or calcified mouse aorta. Whereas elevated phosphate concentrations induced calcification in vitro, FGF23 had no effect on phosphate uptake or phosphate-induced calcification regardless of phosphate concentration or even in the presence of soluble klotho. Thus, in contrast to serum phosphate, FGF23 is not associated with arterial calcification and does not promote calcification experimentally. Hence, phosphate and FGF23 promote cardiovascular disease through distinct mechanisms.

Original languageEnglish (US)
Pages (from-to)1159-1168
Number of pages10
JournalKidney international
Issue number6
StatePublished - Jun 2013
Externally publishedYes


  • Chronic kidney disease
  • Fibroblast growth factor 23
  • Phosphate
  • Vascular calcification
  • Vascular smooth muscle

ASJC Scopus subject areas

  • Nephrology


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