FGF-23, Left Ventricular Hypertrophy, and Mortality in Patients With Chronic Kidney Disease (CKD): A Revisit With Mediation Analysis
Authors' conclusion
In CKD patients, FGF-23 had a minor effect on the development of long-term adverse outcomes through LVH.
Study context
- Population
- Adults with CKD stages 2 to 4 in the CRIC studyof 3,939 enrolled
- Participants
- 2,368 adults
- Comparison
- Highest vs lowest FGF-23 quartile; mediation by left ventricular hypertrophy (LVH)
- Primary endpoint
- Mediational effect of LVH in the pathway from FGF-23 to all-cause mortality, AF and CHF
Methodological detailsmediation analysis, counterfactual mediation analysis, Cox proportional hazards regression
- Mediation analysis
- Counterfactual mediation analysis
- Cox proportional hazards regression
Primary result
As reported in the abstract
Proportion of FGF-23 effect mediated by LVH
All-cause mortality, mediated by LVH
7.4%
Atrial fibrillation (AF), mediated by LVH
11.2%
Congestive heart failure (CHF), mediated by LVH
21.9%
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortality, AF, CHF · median 12.0, 11.1 and 11.1 yearsHighest quartilevs Lowest quartileAll-cause mortality | 1.62 (1.24–2.12) | |
| All-cause mortality, AF, CHF · median 12.0, 11.1 and 11.1 yearsHighest quartilevs Lowest quartileAF | 1.58 (1.12–2.24) | |
| All-cause mortality, AF, CHF · median 12.0, 11.1 and 11.1 yearsHighest quartilevs Lowest quartileCHF | 1.32 (0.95–1.84) | |
| 0.512Hazard ratio (log scale) |
LV mass index · 1 year
- LV mass index positively correlated with FGF-23
Original publication
FGF-23, Left Ventricular Hypertrophy, and Mortality in Patients With CKD: A Revisit With Mediation Analysis. JACC Adv. Published 9 December 2023. doi:10.
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