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Subject Area

Internal Medicine

Article Type

Original Study

Abstract

Objectives To clarify the relationship between fibroblast growth factor-23 (FGF23) and carotid intima-media thickness (CIMT) in nondiabetic chronic kidney disease (CKD) patients on conservative treatment. Background CIMT is a reliable marker of subclinical atherosclerosis, and it has been associated with increased risk of cardiovascular events among CKD. Vascular calcification in CKD patients was independently correlated with FGF23. Patients and methods The study included 75 nondiabetic CKD patients on conservative treatment aged from 20 to 65 years as group 1 and 15 healthy individuals aged from 28 to 61 years, who have no medical history as a control group (group 2). Group 1 was subdivided into two groups: patients with increased CMIT and patients with normal CMIT. The study was conducted from October 2018 to May 2019. The patients were excluded if they have any of the following criteria: acute illness, CKD on dialysis, and patients with diabetes mellitus. The study was a case–control study. All patients and healthy individuals were subjected to the following: full history taking, general demographic data, including age, sex, height, weight, drug history, clinical examination, and laboratory investigations in the form of complete blood count, serum creatinine, and fasting and postprandial blood glucose. Estimated glomerular filtration rate (eGFR) was calculated by the Cockcroft–Gault formula as follows: eGFR=[140 − age (years)]×weight (kg)/serum creatinine (mg/dl)×72 [×0.85 if female], liver function tests (alanine transferase, aspartate transferase, serum albumin level), corrected serum calcium, serum phosphorus, lipid profile, carotid ultrasound, and intact FGF23. Results FGF23 levels and CIMT were significantly increasing across all the stages of CKD. The CIMT is significantly increasing in nondiabetic CKD patients with FGF23 levels of above 190 pg/ml. FGF23 levels positively correlated with the levels of creatinine, calcium, phosphrous, eGFR, hemoglobin, and albumin in nondiabetic CKD patients. Conclusion Nondiabetic CKD patients had higher levels of FGF23 than controls. Nondiabetic CKD patients with increased CIMT had significantly higher phosphorus, creatinine, and FGF23 levels than those with normal CIMT. CIMT and FGF23 were significantly increased across all the stages of CKD. Increasing FGF23 concentrations across the stages of CKD reflect increasing CIMT and progression in CKD nondiabetic patients on conservative treatment.

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