The effect of fibroblast growth factor 23, vitamin D, and renal function on all-cause and cardiovascular mortality : The MrOS Sweden Study

• Background: Fibroblast growth factor 23 (FGF23), parathyroid hormone (PTH), estimated glomerular filtration rate (eGFR), and vitamin D have been linked to mortality and cardiovascular disease, but the limited data addressed the combined effect of these factors on mortality. We investigated these different aspects of mineral bone disease biomarkers that portray independent and prognostic information in the Swedish multicenter prospective Osteoporotic Fractures in Men (MrOS) cohort.Methods: The baseline level of FGF23, PTH, vitamin D, and eGFR was categorized as a normal and abnormal group. The mortality risk of mineral bone markers was analyzed by Kaplan-Meier curve for group difference evaluation and restricted cubic regression spline curve for continuous values of markers. We compare the importance of markers by random forest. Cox proportional regression models were used to evaluate the mortality risk of abnormal mineral bone markers components and their independent effect.Results: The MrOS cohort included 2706 men whose mean aged 75.4±3.18 years, 9.4% had diabetes, and 36.3% had hypertension. During a mean follow-up of 4.48 years, 383 all-cause deaths and 144 cardiovascular deaths were recorded. A high intact FGF23 level, low eGFR, and vitamin D deficiency were associated with increased all-cause mortality. Participants with a combination of high FGF23 level, low eGFR, and vitamin D deficiency had a twofold increased all-cause and cardiovascular mortality risk compared to those without abnormalities after adjusting for confounders. FGF23 was the most important factor related to all-cause mortality in random forest analysis, but the association was attenuated after controlling eGFR in the Cox model. In contrast, a low vitamin D remained to predict all-cause mortality independently.Conclusions: A higher FGF23, lower renal function, and lower vitamin D level are associated with increased all-cause and cardiovascular mortality in elderly men. Renal dysfunction influenced the mortality prediction of FGF23 but not vitamin D.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Urology and Nephrology (hsv//eng)

Nyckelord

fibroblast growth factor 23

vitamin D

renal function

parathyroid hormone

mortality

elderly

Medicinsk vetenskap

Medical Science

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