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Division of Nephrology, Iwate Prefectural Central Hospital Introduction: Levels of fibroblast growth factor 23 (FGF23), a phosphate-regulating hormone, increase with declining kidney function, and 25-hydroxy vitamin D (25-VitD) deficiency is prevalent in patients with chronic kidney disease (CKD). An increase and decrease in FGF23 and 25-VitD levels, respectively, were reported as independent Akt inhibitor risk factors for CKD. We examined the influence of FGF23 and 25-VitD on CKD progression. Methods: We conducted a 3-year prospective observational study involving 150 CKD outpatients with estimated glomerular filtration rates (eGFR) of 5.0 mg/dl, and age < 20 years were excluded. At enrollment, serum FGF23 and
25-VitD levels were measured using enzyme-linked immunosorbent assay kits and by double antibody radioimmunoassays, respectively. The primary outcome was defined as a combination of 50% increase in s-Cre levels and end-stage kidney disease. The survival analysis was performed using Cox regression models. Results: Patients’ mean age was 62 ± 12 (mean ± SD) years and percentage of males was 64.7%. The median FGF23 level (25–75 percentile) was 83 (57–126) pg/mL with log-normal distribution, whereas the mean 25-VitD level was 25.5 ± 9.4 ng/mL. Endonuclease There was no correlation between FGF23 and 25-VitD levels. The mean systolic blood pressure was 135 ± 20 mmHg, serum albumin level was 3.6 ± 0.4 g/dL, phosphate 3.5 ± 0.8 mg/dL, calcium 9.6 ± 0.4 mg/dL,
and eGFR 25.0 ± 12.1 ml/min/1.73 m2. The median urinary protein-to-creatinine ratio (UPCR) and intact parathyroid hormone (PTH) level were 0.99 (0.36–3.03) g/gCr and 62 (39–96) pg/mL. LogFGF23 negatively correlated with eGFR (r = −0.494, P < 0.001) and positively with logPTH (r = 0.312, P < 0.001) and phosphate (r = 0.309, P < 0.001); 25-VitD positively correlated with serum albumin (r = 0.347, P < 0.001) and negatively with UPCR (r = −0.363, P < 0.001). In a three-year follow-up study, 74/150 patients (49%) reached the composite outcome. Hazard ratios of logFGF23 and 25-VitD were 10.6 (CI: 5.4–21.0) and 0.98 (CI: 0.96–1.01), respectively. The hazard ratio of logFGF23 adjusted for baseline characteristics was 3.8 (CI: 1.6–8.9; P = 0.003). Conclusion: The present study showed that FGF23 may be an independent prognostic factor for CKD progression; however, 25-VitD may have no association with it.