A recent study suggests that serum fibroblast growth factor 23 (FGF23), a hormone derived from bone, could serve as an independent biomarker for the early detection of diabetic kidney disease (DKD). This discovery may improve the predictive accuracy of current screening methods, such as the estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR), which are commonly used to assess kidney function in diabetic patients.
Study Methodology
The study, led by researchers from Shanghai Sixth People’s Hospital, involved an analysis of 1,614 individuals with diabetes who participated in a large-scale longitudinal cohort study in China. Participants were aged 55-70, and the study tracked them for an average of 4.6 years. Among the 1,614 participants, 199 were already diagnosed with DKD at the study’s start, while 198 developed the condition during the follow-up period.
FGF23 levels were measured using an enzyme-linked immunosorbent assay (ELISA) at baseline. Participants were subsequently categorized into three risk groups based on their eGFR and ACR values: moderately increased risk, high risk, and very high risk for DKD progression.
Key Findings
The results showed that FGF23 levels were significantly elevated in patients with DKD at baseline, as well as in those who developed incident DKD over the study period. Notably, FGF23 levels increased as DKD severity progressed, though no significant changes were observed in serum calcium or phosphorus levels.
The study’s analysis found that FGF23 was an independent predictor of incident DKD. After adjusting for conventional risk factors, the adjusted odds ratio for FGF23 was 1.290 (95% CI, 1.063-1.565), indicating its significant role in predicting DKD risk. Subgroup analyses further revealed that baseline FGF23 levels also predicted the onset of DKD in individuals with lower body mass index, poorer glycemic control, and a shorter duration of diabetes, as well as in those with baseline diabetic retinopathy.
Importantly, the inclusion of FGF23 in risk prediction models significantly enhanced their performance in forecasting incident DKD.
Clinical Implications
According to the authors, this study highlights the gradual increase in FGF23 levels as DKD progresses, positioning the hormone as a promising tool for early DKD risk prediction. “Our findings suggest that FGF23 could serve as a reliable, independent biomarker for the prediction of DKD, with the potential for early identification in primary care and low-resource settings,” the authors wrote.
Study Limitations
While the study provides valuable insights, there are several limitations to consider. The research was conducted in a community-based cohort of middle-aged and older adults in China, which may limit the applicability of the findings to other populations. Additionally, the diagnosis of DKD was based on albuminuria and reduced eGFR, without the use of renal biopsy for confirmation. The study also relied on a single baseline urine sample, and the relatively short follow-up period of 4.6 years may have restricted the ability to fully assess the relationship between FGF23 and DKD.
Funding and Disclosures
The study was supported by the National Key Research and Development Program of China, the Innovative Research Team of High-level Local Universities in Shanghai, the National Natural Science Foundation of China (NSFC), and other sources. The authors declared no conflicts of interest.
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