11:45pm Thursday 12 December 2019

Researchers Identify a New Marker that Predicts Progressive Kidney Failure and Death in Patients with Chronic Kidney Disease

CKD affects over 20 million Americans and costs the nation nearly $58 billion per year. The findings come from the Chronic Renal Insufficiency Cohort (CRIC) Study, led by principal investigator Harold I. Feldman, MD, MSCE, professor of Medicine, Renal Electrolyte and Hypertension Division, and professor of Epidemiology, and co-principal investigator J. Richard Landis, PhD, professor of Biostatistics.

The CRIC Study follows nearly 4,000 individuals with CKD for the purpose of identifying risk factors for the progression of kidney disease and the development of cardiovascular disease. The current investigation was led by Myles Wolf, MD, MMSc at the University of Miami and was based on a median follow-up period of 3.5 years, during which 266 study participants died and 410 developed kidney failure requiring renal replacement therapy. The study’s Scientific and Data Coordinating Center is located at the Perelman School of Medicine.

Researchers report that among patients with earlier stage kidney disease, elevations in fibroblast growth factor 23 (FGF23), a novel hormone regulating phosphate metabolism, were linked to a 1.7-fold higher risk of kidney failure if their baseline estimated glomerular filtration rate (eGFR) was 45 ml/min/1.73m² or higher. Among all CKD patients regardless of their eGFR, the highest FGF23 levels were associated with a 3-fold higher risk of death compared to lower levels of the hormone. The eGFR is a measure of kidney function.

Phosphorus is needed to build and repair bones and teeth, help cells function and maintain DNA. The kidneys, supported by regulatory hormones like FGF23, help control the amount of phosphate in the blood by eliminating the excess. Kidney damage is associated with elevated phosphate levels, which, in turn, may also worsen kidney disease.

“FGF23 is one of the strongest predictors of poor outcomes among CRIC Study participants all of whom have CKD,” said Feldman. “FGF23 represents an exciting new possible target for therapies that could reduce the enormous burden of disease in this population.”

This research was also supported by NIH’s National Center for Research Resources. For more information, please read the NIDDK release.



Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $4 billion enterprise.

Penn’s Perelman School of Medicine is currently ranked #2 in U.S. News & World Report’s survey of research-oriented medical schools and among the top 10 schools for primary care. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $507.6 million awarded in the 2010 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania — recognized as one of the nation’s top 10 hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania Hospital – the nation’s first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services throughout the Philadelphia region.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2010, Penn Medicine provided $788 million to benefit our community.

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