The FGF23–Klotho axis and cardiac tissue Doppler imaging in pediatric chronic kidney disease—a prospective cohort study

• Published in: Pediatric nephrology (Berlin, West) West), 2018-01, Vol.33 (1), p.147-157
• Main Authors: Tranæus Lindblad, Ylva, Olauson, Hannes, Vavilis, Georgios, Hammar, Ulf, Herthelius, Maria, Axelsson, Jonas, Bárány, Peter
• Format: Article
• Language: English
• Subjects: Adolescent; Biomarkers - blood; Bone diseases; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - etiology; Child; Child, Preschool; Cohort analysis; Cohort Studies; Development and progression; Doppler effect; Echocardiography, Doppler; Female; Fibroblast growth factor 23; Fibroblast Growth Factors - blood; Glomerular Filtration Rate; Glucuronidase - blood; Health risk assessment; Heart - diagnostic imaging; Heart diseases; Humans; Hyperphosphatemia; Infant; Kidney diseases; Kidney transplantation; Kidney transplants; Klotho protein; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Minerals; Morbidity; Nephrology; Original; Original Article; Pediatrics; Prospective Studies; Renal failure; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - complications; Risk factors; Urology; Ventricle
• ISSN: 0931-041X; 1432-198X; 1432-198X
• DOI: 10.1007/s00467-017-3766-5

Background Chronic kidney disease-associated mineral bone disorder (CKD-MBD) is common in pediatric kidney disease patients and a risk factor for future cardiovascular disease (CVD). Fibroblast growth factor-23 (FGF23) and Klotho are novel key players in CKD-MBD, and has been suggested to be involved in the development of CVD. Methods This prospective cohort study included 74 pediatric patients; 31 with CKD (age range 0.8–18.8 years, glomerular filtration rate (GFR) range 9–68 mL/min/1.73 m 2 ) and 43 transplanted patients (CKD-T; age range 3.3–17.7 years, GFR range 10–99 mL/min/1.73 m 2 ) examined annually for 3 years. We assessed longitudinal patterns and predictors of FGF23 and soluble Klotho, as well as associations to cardiac remodeling and function using echocardiographic pulse wave Doppler (PWD) and color-coded tissue Doppler imaging (cc-TDI). Results The prevalence of high FGF23 levels (≥95th percentile) was 60% in CKD and 42% in CKD-T patients, despite a low prevalence of hyperphosphatemia and normal Klotho levels. Low GFR at baseline was a predictor for high mean log FGF23 during follow-up in CKD and CKD-T patients (β = −0.2, p