FGF23 and inflammation, anemia, and iron

Abstract Chronic kidney disease is a common condition that is characterized by anemia, inflammation, disordered iron homeostasis, and early increases in fibroblast growth factor 23 (FGF23) levels. Complex interrelationships exist among FGF23, inflammation, and anemia-related factors. Via multiple direct and indirect mechanisms, intact FGF23 inhibits erythropoiesis, thus promoting the development of anemia. Additionally, intact FGF23 can directly induce production of pro-inflammatory cytokines. Conversely, anemia-related factors and inflammation affect FGF23 production and metabolism, suggesting the presence of bi-directional relationships between FGF23 and erythropoiesis and between FGF23 and inflammation.