Fibroblast Growth Factor 23 Induces Left Ventricular Hypertrophy

Background: Cardiovascular disease is the primary cause of death in chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) mediates this relationship and its prevalence drastically rises throughout the course of CKD. Patients with CKD develop marked elevations in circulating levels of the phosphorus-regulating hormone, ibroblast growth factor (FGF) 23, and these levels increase progressively as the renal capacity for phosphorus excretion declines. While compensatory elevations in FGF23 maintain normal serum phosphate levels, recent prospective clinical studies demonstrated a dose-dependent association between elevated FGF23 levels and greater risks of major cardiovascular events and mortality. FGF23 was independently associated with greater left ventricular mass and greater prevalence of LVH. However, these small cross-sectional studies were unable to determine whether FGF23 directly contributes to LVH or is simply a biomarker of toxicity of other factors.