VA Eastern Colorado Healthcare System, Aurora, Colorado.
University of Colorado Anschutz Medical Campus, Aurora, Colorado.
J Am Geriatr Soc. 2021 Feb;69(2):467-473. doi: 10.1111/jgs.16895. Epub 2020 Dec 1.
BACKGROUND/OBJECTIVES: Chronic kidney disease (CKD) is associated with frailty. Fibroblast growth factor 23 (FGF23) is elevated in CKD and associated with frailty among non-CKD older adults and individuals with human immunodeficiency virus. Whether FGF23 is associated with frailty and falls in CKD is unknown.
Cross-sectional and longitudinal observational study.
Systolic Blood Pressure Intervention Trial (SPRINT), a randomized trial evaluating standard (systolic blood pressure [SBP] <140 mm Hg) versus intensive (SBP <120 mm Hg) blood pressure lowering on cardiovascular and cognitive outcomes among older adults without diabetes mellitus.
A total of 2,376 participants with CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m ).
The exposure variable was intact FGF23. We used multinomial logistic regression to determine the cross-sectional association of intact FGF23 with frailty and Cox proportional hazards analysis to determine the longitudinal association with incident falls. Models were adjusted for demographics, comorbidities, randomization group, antihypertensives, eGFR, mineral metabolism markers, and frailty.
After adjustment, the odds ratio for prevalent frailty versus non-frailty per twofold higher FGF23 was 1.34 (95% confidence interval [CI] = 1.01-1.77). FGF23 levels in the highest quartile versus the lowest quartile demonstrated more than a twofold increased fall risk (hazard ratio [HR] = 2.32; 95% CI = 1.26-4.26), and the HR per twofold higher FGF23 was 1.99 (95% CI = 1.48-2.68).
Among SPRINT participants with CKD, FGF23 was associated with prevalent frailty and falls.
背景/目的：慢性肾脏病（CKD）与虚弱有关。成纤维细胞生长因子 23（FGF23）在 CKD 中升高，与非 CKD 老年人和人类免疫缺陷病毒个体的虚弱有关。FGF23 是否与 CKD 中的虚弱和跌倒有关尚不清楚。
横断面和纵向观察性研究。
收缩压干预试验（SPRINT），一项随机试验，评估标准（收缩压[SBP] <140mmHg）与强化（SBP <120mmHg）降压对无糖尿病老年人心血管和认知结局的影响。
共有 2376 名 CKD 患者（估算肾小球滤过率[eGFR] <60mL/min/1.73m ）。
暴露变量为完整的 FGF23。我们使用多项逻辑回归来确定完整 FGF23 与虚弱的横断面关联，使用 Cox 比例风险分析来确定与新发跌倒的纵向关联。模型调整了人口统计学、合并症、随机分组、抗高血压药物、eGFR、矿物质代谢标志物和虚弱。
调整后，每两倍更高的 FGF23 ，现有虚弱与非虚弱的比值比为 1.34（95%置信区间[CI] = 1.01-1.77）。与最低四分位数相比，最高四分位数的 FGF23 水平跌倒风险增加了两倍以上（风险比[HR] = 2.32；95%CI = 1.26-4.26），每两倍更高的 FGF23 的 HR 为 1.99（95%CI = 1.48-2.68）。
在 SPRINT 患有 CKD 的参与者中，FGF23 与现有虚弱和跌倒有关。
