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J Am Geriatr Soc. 2016 Feb;64(2):270-6. doi: 10.1111/jgs.13951.

Fibroblast Growth Factor-23 and Frailty in Elderly Community-Dwelling Individuals: The Cardiovascular Health Study.

Author information

1
Division of Nephrology, University of California at San Diego, San Diego, California.
2
Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California.
3
Department of Medicine, University of California at San Francisco, San Francisco, California.
4
General Internal Medicine Section, San Francisco Veterans Affairs Medical Center, San Francisco, California.
5
Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
6
Department of Medicine, University of Pittsburgh and Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
7
Nephrology Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
8
Department of Laboratory Medicine, University of Washington, Seattle, Washington.
9
Division of Renal Disease and Hypertension, University of Colorado at Denver, Denver, Colorado.
10
Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington.

Abstract

OBJECTIVES:

To evaluate whether fibroblast growth factor 23 (FGF-23) is related to frailty and to characterize the nature of their joint association with mortality.

DESIGN:

Cross-sectional analysis for frailty and longitudinal cohort analysis for mortality.

SETTING:

Cardiovascular Health Study.

PARTICIPANTS:

Community-dwelling individuals (N = 2,977; mean age 77.9 ± 4.7, 40% male, 83% white).

MEASUREMENTS:

The predictor was serum FGF-23 concentration (C-terminal enzyme-linked immunosorbent assay), and the outcomes were frailty status (determined according to frailty phenotype criteria of weight loss, weakness, exhaustion, slowness, and low physical activity) and mortality. Multinomial logistic regression was used to assess the cross-sectional association between FGF-23 and frailty and prefrailty, adjusting for demographic characteristics, cardiovascular disease and risk factors, and kidney markers. Proportional hazards Cox proportional hazards regression was used to assess the association between FGF-23, frailty, and all-cause mortality.

RESULTS:

Mean estimated glomerular filtration rate (eGFR) was 64 ± 17 mL/min per 1.73 m(2) . Median FGF-23 was 70.3 RU/mL (interquartile range 53.4-99.2); 52% were prefrail, and 13% were frail. After multivariate adjustment, each doubling in FGF-23 concentration was associated with 38% (95% confidence interval (CI) = 17-62%) higher odds of frailty than of nonfrailty and 16% (95% CI = 3-30%) higher odds of prefrailty. FGF-23 (hazard ratio (HR) = 1.16, 95% CI = 1.10-1.23) and frailty (HR = 1.82, 95% CI = 1.57-2.12) were independently associated with mortality, but neither association was meaningfully attenuated when adjusted for the other.

CONCLUSION:

In a large cohort of older adults, higher FGF-23 was independently associated with prevalent frailty and prefrailty. FGF-23 and frailty were independent and additive risk factors for mortality. FGF-23 may be a marker for functional outcomes.

KEYWORDS:

fibroblast growth factor 23; frailty; mortality

PMID:
26889836
PMCID:
PMC5510331
DOI:
10.1111/jgs.13951
[Indexed for MEDLINE]
Free PMC Article

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