Fibroblast growth factor 23 is related to profiles indicating volume overload, poor therapy optimization and prognosis in patients with new-onset and worsening heart failure

Jozine M. Ter Maaten, Adriaan A. Voors (Lead / Corresponding author), Kevin Damman, Peter van der Meer, Stefan D. Anker, John G. Cleland, Kenneth Dickstein, Gerasimos Filippatos, Pim van der Harst, Hans L. Hillege, Chim C. Lang, Marco Metra, Gerjan Navis, Leong Ng, Wouter Ouwerkerk, Piotr Ponikowski, Nilesh J. Samani, Dirk J. van Veldhuisen, Faiez Zannad, Aeilko H. ZwindermanMartin H. de Borst

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Abstract

BACKGROUND: Fibroblast growth factor (FGF) 23 is a hormone that increases urinary phosphate excretion and regulates renal sodium reabsorption and plasma volume. We studied the role of plasma FGF23 in therapy optimization and outcomes in patients with new-onset and worsening heart failure (HF).

METHODS: We measured plasma C-terminal FGF23 levels at baseline in 2399 of the 2516 patients included in the BIOlogy Study to Tailored Treatment in Chronic HF (BIOSTAT-CHF) trial. The association between FGF23 and outcome was evaluated by Cox regression analysis adjusted for potential confounders.

RESULTS: Median FGF23 was 218.0 [IQR: 117.1-579.3] RU/ml; patients with higher FGF23 levels had a worse NYHA class, more signs of congestion, and were less likely to use an ACE-inhibitor (ACEi) or angiotensin receptor blocker (ARBs) at baseline (all P<0.01). Higher FGF23 levels were independently associated with higher BNP, lower eGFR, the presence of oedema and atrial fibrillation (all P<0.001). In addition, higher FGF23 was independently associated with impaired uptitration of ACEi/ARBs after 3months, but not of beta-blockers. In multivariable Cox regression analysis, FGF23 was independently associated with all-cause mortality (hazard ratio: 1.17 (1.09-1.26) per log increase, P<0.001), and the combined endpoint of all-cause mortality and HF hospitalization (1.15 (1.08-1.22) per log increase, P<0.001).

CONCLUSIONS: In patients with new-onset and worsening HF, higher plasma FGF23 levels were independently associated with volume overload, less successful uptitration of ACEi/ARBs and an increased risk of all-cause mortality and HF hospitalization.

Original languageEnglish
Pages (from-to)84-90
Number of pages7
JournalInternational Journal of Cardiology
Volume253
Early online date3 Jan 2018
DOIs
Publication statusPublished - 15 Feb 2018

Keywords

  • FGF23
  • Heart failure
  • Prognosis
  • Volume overload

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    Ter Maaten, J. M., Voors, A. A., Damman, K., van der Meer, P., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., van der Harst, P., Hillege, H. L., Lang, C. C., Metra, M., Navis, G., Ng, L., Ouwerkerk, W., Ponikowski, P., Samani, N. J., van Veldhuisen, D. J., Zannad, F., ... de Borst, M. H. (2018). Fibroblast growth factor 23 is related to profiles indicating volume overload, poor therapy optimization and prognosis in patients with new-onset and worsening heart failure. International Journal of Cardiology, 253, 84-90. https://doi.org/10.1016/j.ijcard.2017.10.010