Serum FGF-23 and Vitamin D Deficiency as Predictors of Metabolic Syndrome in Chronic Kidney Disease
DOI:
https://doi.org/10.36283/ziun-pjmd14-2/051Keywords:
FGF-23 , Vitamin D, Metabolic Syndrome X, Chronic Kidney Disease , Cardiovascular Diseases , Insulin ResistanceAbstract
Background: Chronic kidney disease (CKD) is closely linked to disruptions in mineral metabolism and a high prevalence of metabolic syndrome. This study explored the relationship between serum fibroblast growth factor 23 (FGF-23), vitamin D deficiency, and metabolic syndrome in CKD patients.
Methods: A cross-sectional study was conducted from June 2024 to December 2024 at Liaquat University of Medical and Health Sciences, Jamshoro. Using purposive sampling, 200 CKD patients aged 18 years or older were included. Serum FGF-23 and vitamin D levels were measured, and metabolic syndrome was defined using NCEP ATP III criteria. Data was analyzed via SPSS for measures of central tendency and correlation, with p<0.05 considered statistically significant.
Results: Among 200 participants, 196 (98%) had metabolic syndrome. Serum FGF-23 levels rose significantly with advancing CKD stages (Stage 1: 120.5 ± 50.6 pg/mL; Stage 5: 680.3 ± 90.4 pg/mL, p<0.01), while vitamin D levels decreased (Stage 1: 25.6 ± 4.2 ng/mL; Stage 5: 10.2 ± 2.3 ng/mL, p<0.01). FGF-23 showed a weak positive correlation with fasting glucose (r=0.16, p=0.03), and vitamin D negatively correlated with blood pressure (r=-0.11, p=0.04). Logistic regression identified elevated FGF-23 (OR=1.05, p<0.01), low vitamin D (OR=0.95, p=0.02), and older age (OR=1.06, p<0.01) as predictors of metabolic syndrome.
Conclusion: Metabolic syndrome was prevalent in 98% of CKD patients, primarily driven by elevated FGF-23 and vitamin D deficiency. Addressing these factors may help reduce cardiovascular risks and improve CKD outcomes.
References
Yoon HE, Lim SW. Roles of parathyroid hormone and fibroblast growth factor 23 in advanced chronic kidney disease. Endocrinol Metab (Seoul). 2024;39(3):373-383. doi:10.3803/EnM.2024.1978.
Khan S, Jabeen F, Arif F. Fibroblast growth factor 23 as a biomarker of bone and mineral disorders in chronic kidney disease. Clin Kidney J. 2023;16(5):1023-1030. doi:10.1093/ckj/sfac244.
Wimalawansa SJ. Vitamin D deficiency in chronic kidney disease: Pathophysiology and management. J Steroid Biochem Mol Biol. 2020;200:105654. doi:10.1016/j.jsbmb.2020.105654.
Shroff R, Wan M, Gutiérrez O. The role of FGF23 in CKD-MBD and cardiovascular disease: Lessons from genetics. Bone. 2021;143:115817. doi:10.1016/j.bone.2020.115817.
Isakova T, Cai X, Lee J, et al. Fibroblast growth factor 23 and risks of mortality and end-stage kidney disease in patients with CKD. JAMA. 2021;325(20):2016-2028. doi:10.1001/jama.2021.4587.
Pilz S, März W, Cashman KD, et al. Vitamin D and cardiovascular disease: Updated evidence. Rev Endocr Metab Disord. 2021;22(4):857-865. doi:10.1007/s11154-021-09627-2.
Stöhr R, Schuh A, Heine GH, Brandenburg V. FGF23 in cardiovascular disease: Innocent bystander or active mediator? Front Endocrinol (Lausanne). 2022;13:836090. doi:10.3389/fendo.2022.836090.
Mirza MA, Larsson A, Melhus H, et al. FGF23 and inflammation: A link between metabolic disorders and mineral dysregulation. Atherosclerosis. 2023;364:27-34. doi:10.1016/j.atherosclerosis.2023.02.008.
Razzaque MS. The FGF23-Klotho axis: Endocrine regulation of phosphate homeostasis. Int J Mol Sci. 2021;22(12):6209. doi:10.3390/ijms22126209.
Sahota O, Barnett A. Vitamin D supplementation and its impact on CKD patients. BMJ Open. 2021;11(7):e046720. doi:10.1136/bmjopen-2020-046720.
Di Iorio B, Bellasi A. FGF23 modulation and cardiovascular risk in CKD. Nephrol Dial Transplant. 2020;35(7):1130-1137. doi:10.1093/ndt/gfaa013.
Moe SM, Drüeke TB. Management of mineral and bone disorders in chronic kidney disease. Kidney Int Suppl. 2022;12(3):49-57. doi:10.1016/j.kisu.2022.06.005.
Wang AY, Weng SH. CKD and metabolic syndrome interplay in Asian populations. J Clin Med. 2022;11(6):1501. doi:10.3390/jcm11061501.
Ureña-Torres P, Metzger M, Haymann JP, et al. Association between CKD progression and metabolic syndrome components. Kidney Int. 2021;99(4):1047-1056. doi:10.1016/j.kint.2020.12.016.
Fernández-Martín JL, Martín-Malo A, et al. Role of FGF23 in CKD-associated metabolic disorders. Front Endocrinol (Lausanne). 2022;13:931231. doi:10.3389/fendo.2022.931231.
Kovesdy CP. Epidemiology of metabolic syndrome in CKD: Current evidence and future directions. Nephrol Dial Transplant. 2023;38(2):113-121. doi:10.1093/ndt/gfab223.
Stubbs JR, Liu S, Quarles LD. Role of FGF23 in metabolic and cardiovascular risks. J Nephrol. 2022;35(5):1287-1298. doi:10.1007/s40620-022-01350-7.
Holick MF, Chen TC. Vitamin D deficiency and metabolic health. Trends Endocrinol Metab. 2020;31(2):91-103. doi:10.1016/j.tem.2019.10.002.
Fliser D, Kollerits B, Neyer U, et al. Fibroblast growth factor 23 (FGF23) predicts progression of chronic kidney disease: The Mild to Moderate Kidney Disease (MMKD) Study. J Am Soc Nephrol. 2007;18(8):2600-2608. doi:10.1681/ASN.2006080936.
Gutierrez OM, Mannstadt M, Isakova T, et al. Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med. 2008;359(6):584-592. doi:10.1056/NEJMoa0706130.
Gutiérrez O, Isakova T, Rhee E, et al. Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease. J Am Soc Nephrol. 2005;16(7):2205-2215. doi:10.1681/ASN.2005010052.
Wolf M, Forging SL, et al. Elevated fibroblast growth factor 23 is a risk factor for kidney transplant loss and mortality. J Am Soc Nephrol. 2011;22(5):956-966. doi:10.1681/ASN.2010080801.
Seiler S, Cremers B, Rebling NM, et al. The phosphatonin fibroblast growth factor 23 links calcium-phosphate metabolism with left-ventricular dysfunction and heart failure. Kidney Int. 2010;77(10):950-956. doi:10.1038/ki.2010.12.
Ketteler M, Biggar P. Insights into the emerging role of FGF23 in metabolic syndrome. Nat Rev Nephrol. 2023;19(3):145-159. doi:10.1038/s41581-023-00599-y.
Mehrotra R, Lee J, et al. Serum biomarkers of vascular calcification and FGF23 in CKD: Implications for clinical outcomes. Am J Kidney Dis. 2023;82(2):213-225. doi:10.1053/j.ajkd.2023.03.008.
Wright JD, Nambi V, et al. A study of FGF23 and atherosclerosis development in CKD populations. Arterioscler Thromb Vasc Biol. 2023;43(1):91-100. doi:10.1161/ATVBAHA.122.318777.
Hou Y, Liu Y, et al. Examining FGF23-mediated mineral imbalances and CKD progression. Sci Rep. 2022;12(8):4455. doi:10.1038/s41598-022-44455-w.
Barreto FC, Liabeuf S, et al. The impact of elevated FGF23 levels on endothelial dysfunction in CKD patients. Nephrol Dial Transplant. 2021;36(7):1300-1309. doi:10.1093/ndt/gfz322.
Shao JS, Cheng S, et al. Potential interventions targeting FGF23-related mineral dysregulation in CKD. Clin Nephrol. 2021;96(5):241-249. doi:10.5414/CN110788.
Chowdhury R, Yadav VK, et al. Linking bone metabolism, FGF23, and cardiovascular outcomes in chronic kidney disease. Front Med (Lausanne). 2023;10:1143201. doi:10.3389/fmed.2023.1143201.
Isakova T, Wolf M, et al. Mechanistic studies linking FGF23 with vascular calcification. Nephrol Dial Transplant. 2022;37(1):231-240. doi:10.1093/ndt/gfab051.

Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/