Document Detail


Fibroblast growth factor 23, high-sensitivity cardiac troponin, and left ventricular hypertrophy in CKD.
MedLine Citation:
PMID:  22883134     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Detectable levels of cardiac troponins are common in individuals with chronic kidney disease (CKD), even in the absence of symptomatic cardiovascular disease. Abnormal cardiac troponin values are associated with coronary artery disease and left ventricular hypertrophy (LVH) and predict poor clinical outcomes. Elevated levels of fibroblast growth factor 23 (FGF-23) contribute to LVH in CKD. We investigated the association of FGF-23 and hs-cTnI (high-sensitivity cardiac troponin I) and hs-cTnT (high-sensitivity cardiac troponin T) levels in CKD and examined the role of LVH in this association.
STUDY DESIGN: Cross-sectional observational study.
SETTING & PARTICIPANTS: 153 stable outpatients with non-dialysis-dependent CKD.
PREDICTOR: The primary predictor was FGF-23 level.
OUTCOMES: hs-cTnI, hs-cTnT.
MEASUREMENTS: FGF-23, hs-cTnI, hs-cTnT; left ventricular mass index (LVMI) assessed by echocardiography; coronary artery calcification (CAC) measured by computed tomography. LVMI and CAC were evaluated as potential mediators of the effect of FGF-23 on hs-cTnI/T.
RESULTS: Mean age was 64 ± 12 (SD) years, mean estimated glomerular filtration rate was 34 ± 11 mL/min/1.73 m(2), median FGF-23 level was 120 (25th-75th percentile, 79-223) reference unit (RU)/mL, median hs-cTnI level was 6.5 (25th-75th percentile, 3.5-14.5) pg/mL, and median hs-cTnT level was 16.8 (25th-75th percentile, 11.1-33.9) pg/mL. cTnI and cTnT concentrations were higher than the 99th percentile of a healthy population in 42% and 61% of patients, respectively. In unadjusted and multivariable-adjusted analyses, hs-cTnI/T levels were associated significantly with FGF-23 levels. Adjusting for LVMI, but not CAC, weakened the association of FGF-23 and hs-cTnI/T levels.
LIMITATIONS: Vitamin D levels were not measured. The prevalence of coronary artery disease may have been underestimated because it was ascertained by self-report.
CONCLUSIONS: Minimally elevated cTnI and cTnT levels, detectable by high-sensitivity assays, are associated with elevated FGF-23 levels in stable outpatients with CKD. FGF-23-associated LVH may contribute to detectable hs-cTnI/T levels observed in non-dialysis-dependent patients with CKD.
Authors:
Kelsey Smith; Christopher deFilippi; Tamara Isakova; Orlando M Gutiérrez; Karen Laliberte; Stephen Seliger; Walter Kelley; Show-Hong Duh; Michael Hise; Robert Christenson; Myles Wolf; James Januzzi
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-08-09
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  61     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-18     Completed Date:  2013-02-21     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  67-73     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood
Comorbidity
Coronary Artery Disease / epidemiology
Cross-Sectional Studies
Echocardiography
Female
Fibroblast Growth Factors / blood*
Glomerular Filtration Rate / physiology
Humans
Hypertrophy, Left Ventricular / blood*,  epidemiology*,  ultrasonography
Male
Middle Aged
Multivariate Analysis
Prevalence
Prognosis
Renal Insufficiency, Chronic / blood*,  epidemiology*,  physiopathology
Sensitivity and Specificity
Troponin I / blood*
Grant Support
ID/Acronym/Agency:
K23 DK087858/DK/NIDDK NIH HHS; K24 DK093723/DK/NIDDK NIH HHS; K30RR02229207/RR/NCRR NIH HHS; M01RR01066/RR/NCRR NIH HHS; R01 DK076116/DK/NIDDK NIH HHS; R01 DK081374/DK/NIDDK NIH HHS; R01DK076116/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Troponin I; 0/fibroblast growth factor 23; 62031-54-3/Fibroblast Growth Factors
Comments/Corrections

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