Serum fibroblast growth factor-23 and risk of incident chronic kidney disease in older community-dwelling women

Richard D. Semba, Jeffrey C. Fink, Kai Sun, Anne R. Cappola, Mansi Dalal, Candace Crasto, Luigi Ferrucci, Linda P. Fried

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background and objectives Elevated circulating fibroblast growth factor 23 (FGF23) predicts progression of CKD, but it is unknown whether circulating FGF23 independently predicts incident CKD. This study aimed to determine whether circulating FGF23 predicts incident CKD in community-dwelling women. Design, setting, participants, & measurements This study examined the relationship of intact serum FGF23, 1,25-dihydroxyvitamin D 3 (1,25[OH] 2D), 25-hydroxyvitamin D (25[OH]D), parathyroid hormone, calcium, and phosphate with prevalent and incident CKD in 701 disabled women, ≥65 years of age, from the Women's Health and Aging Study I in Baltimore, Maryland, from 1993 to 1997. Incident CKD was defined as a low estimated GFR (eGFR),<60 ml/min per 1.73 m 2 only, low eGFR,<60 ml/min per 1.73 m 2 and a ≥25% decline in eGFR from baseline, and an increase in serum creatinine (≥0.4 mg/dl) at follow-up. Results At baseline, 381 women (54.3%) had stage 3 CKD. Of 307 women without CKD at baseline, 63 (20.5%) developed stage 3 CKD over 24 months of follow-up. After excluding prevalent cases of CKD, FGF23 (per 1 SD increase) was associated with incident stage 3 CKD (hazard ratio [HR], 1.51; 95% confidence interval [95% CI], 1.06, 2.16; P=0.02), low and declining eGFR (HR, 3.69; 95% CI, 1.68, 8.11; P=0.001), and increase in serum cre-atinine (HR, 5.35; 95% CI, 1.27, 22.54; P=0.02) in respective multivariable Cox proportional hazards models adjusting for baseline eGFR, age, race, phosphate, 1,25-dihydroxyvitamin D 3, parathyroid hormone, and other potential confounders.Conclusions Elevated FGF23 is an independent risk factor for incident CKD in older, disabled, community-dwelling women.

Original languageEnglish (US)
Pages (from-to)85-91
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Issue number1
StatePublished - Jan 1 2012

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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