Serum fibroblast growth factor 23 levels in chronic kidney disease and its correlation with bio-chemical parameters in chronic kidney disease: a cross sectional comparative study


  • Priya Anbarasan Department of Biochemistry, Government Thiruvarur Medical College, Thiruvarur, Tamil Nadu, India
  • Vinoth Khanna Department of Medicine, Government Thiruvarur Medical College, Thiruvarur, Tamil Nadu, India



Chronic kidney disease, Fibroblast growth factor, GFR, Serum phosphate


Background: Globally, chronic kidney disease (CKD) is a major public health problem. Fibroblast growth factor (FGF)-23 is a newly recognized phosphatonin secreted by the osteocytes which acts as a key regulator of serum phosphate levels in CKD. In the present study, we aimed to estimate the levels of serum FGF-23 in patients with CKD and to compare them with healthy controls. Also, we aimed to compare the levels of FGF-23 levels with creatinine clearance and kidney size in various stages of CKD.

Methods: A cross sectional comparative study was conducted at Thiruvarur Government Medical College hospital in Tamil Nadu. Patients aged between 20 and 65 years with an established diagnosis of CKD and healthy controls were included in the study. Enzyme Immuno-Assay method was followed for the estimation of FGF-23. Spot Urine sample was collected to determine the presence of albumin. Serum levels of glucose, Urea, Creatinine, Electrolytes (Sodium, Potassium), Albumin, Calcium, Phosphorus and Alkaline Phosphatase were measured. Information on kidney size, cortical echogenicity, parenchymal thickness and cortico-medullary differentiation were assessed based on ultrasound abdomen.

Results: A total of 45 CKD cases and 45 healthy controls were studied. Mean (SD) age of CKD cases was 54(11) years and that of controls was 46(9.6) years. The mean value of FGF23 in cases was 730.7±492.7 pg/ml and this was higher than that of the control group whose mean value was 39.49±12.47 pg/ml (P<0.05). Mean GFR levels in cases and controls were 23.8 and 113.8 and this difference was statistically significant (P value<0.0001). Among cases, Pearson correlation between serum FGF-23 levels and eGFR, serum albumin was statistically significant and had a negative inverse correlation.

Conclusions: The present study demonstrated that serum FGF23 levels were significantly increased in patients with CKD. This increase in serum FGF23 levels were progressive from the early stages to the late stages of CKD. 


Agarwal SK. Chronic kidney disease and its prevention in India. Kidney Int Suppl. 2005 Sep;(98):S41-5.

Shafi P, Coresh J. Chronic Kidney Disease; Definition, Epidemiology, Cost and Outcomes. In: Jonathan Himmelfarb, Mohamed H Sayegh Chronic Kidney Disease, Dialysis and Transplantation. 3rd Ed. Elsevier Saunders;2010:3.

Wahl P, Wolf M. FGF23 in Chronic Kidney Disease. In: Makoto K, editor. Endocrine FGFs and Klothos. Springer. 2012:107-125.

Heine GH, Seiler S, Fliser D. FGF-23: the rise of a novel cardiovascular risk marker in CKD. Nephrol Dial Transplant. 2012;27(8):3072-81.

Wolf M. Update on fibroblast growth factor 23 in chronic kidney disease. Kidney Int. 2012;82(7):737-47.

Jean G, Terrat JC, Vanel T, Hurot JM, Lorriaux C, Mayor B, et al. High levels of serum fibroblast growth factor (FGF)-23 are associated with increased mortality in long haemodialysis patients. Nephrol Dial Transplant. 2009;24(9):2792-6.

Craver L, Marco MP, Martinez I, Rue M, Borras M, Martin ML, et al. Mineral metabolism parameters throughout chronic kidney disease stages 1-5--achievement of K/DOQI target ranges. Nephrol Dial Transplant. 2007;22(4):1171-6.

Sprecher E. Familial tumoral calcinosis: from characterization of a rare phenotype to the pathogenesis of ectopic calcification. J Invest Dermatol. 2010;130(3):652-60.

Isakova T, Gutierrez O, Shah A, Castaldo L, Holmes J, Lee H, et al. Postprandial mineral metabolism and secondary hyperparathyroidism in early CKD. J Am Soc Nephrol. 2008;19(3):615-23.

Munikrishnappa D. Limitations of Various Formulae and Other Ways of Assessing GFR in the Elderly: Is There a Role for Cystatin C ? In: American Society of Nephrology. Geriatrics nephrology curriculum. Washington; 2009:1-7.

Weber TJ, Liu S, Indridason OS, Quarles LD. Serum FGF23 levels in normal and disordered phosphorus homeostasis. J Bone Miner Res. 2003;18(17):1227-34.

Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005;112(17):2627-33.

Mackay EM, Oliver J. Renal damage following the ingestion of a diet containing an excess of inorganic phosphate. J Exp Med. 1935;61(3):319-34.

Jono S, McKee MD, Murry CE, Shioi A, Nishizawa Y, Mori K, et al. Phosphate regulation of vascular smooth muscle cell calcification. Circ Res. 2000;87(7):e10-7.






Original Research Articles