Fractional Excretion of Phosphorus Modifies the Association between Fibroblast Growth Factor-23 and Outcomes

摘要: Fibroblast growth factor-23 (FGF23) induces phosphaturia through its effects on renal tubules. Higher levels of FGF23 associate with cardiovascular disease (CVD) events and all-cause mortality, but it is unknown whether these associations differ by the degree phosphaturia. Here, we measured serum 24-hour urine fractional excretion phosphorus (FePi) in 872 outpatients stable CVD a mean estimated GFR 71 ml/min per 1.73 m(2). During an average 7.5 years follow-up, there were 337 deaths 199 events. Urinary FePi significantly modified association each outcome (P interaction<0.001 for mortality P interaction<0.05 events). In models adjusted risk factors, kidney function, PTH, those patients who had above median (≥ 42.3 relative units [RU]/ml) below (<15.7%) highest risks both (HR=1.98, 95% CI=1.42-2.77) (HR=1.92, CI=1.25-2.94) compared low concentrations FePi. summary, are stronger persons lower independent PTH function. such individuals, tubular response to may be suboptimal.