New Marker to Predict Progressive Kidney Failure -- MEDICA - World Forum for Medicine

New Marker to Predict Progressive Kidney Failure

Photo: Futuristic image of a kidney

Two million people worldwide
depend on dialysis to treat kidney
failure;© /
Vishnukumar Sivaraman

In a previous study of patients beginning hemodialysis for treatment of kidney failure, individuals with elevated blood levels of the hormone fibroblast growth factor 23 (FGF23) were found to be at nearly six times greater risk of death compared to those with lower levels. However, the hormone had not been tested in the much larger population of patients with less advanced CKD.

Researchers now report that patients with earlier stage kidney disease and high FGF23 are at nearly two times higher risk of kidney failure if their baseline estimated glomerular filtration rate (eGFR) is 45 milliliters or higher, while all CKD patients are at three times higher risk of death compared to patients with lower levels of the hormone. The eGFR is a measure of kidney function.

"Since FGF23 rises before phosphate in people with early or intermediate-stage chronic kidney disease, this hormone could be an early marker — like a road sign — pointing to patients who may benefit from early management of phosphate levels, which may help preserve kidney function and reduce deaths," said Doctor Myles Wolf, at the University of Miami.

Our bodies need phosphorus to build and repair bones and teeth, help cells function and maintain DNA. With fine-tuned regulation from hormones like FGF23, the kidneys help control the amount of phosphate in the blood by eliminating the excess. Elevated phosphate levels are often a consequence of advanced kidney disease or damage. But too much phosphate may also make kidney disease worse.

"The major goal of the CRIC Study is to figure out which factors might predict rapid loss of kidney function and development and worsening of heart disease in CKD patients," said Doctor Robert A. Star, director of the Division of Kidney, Urologic and Hematologic Diseases at NIDDK. "FGF23 could be the critically important puzzle piece that separates those who might have stable kidney function from those who have progressively worsening kidney disease and heart disease that requires more intensive therapy. FGF23 might work better than more traditional measures, such as protein in the urine, in certain settings."; Source: National Institutes of Health (NIH)