Baseline intact fibroblast growth factor 23 and risk of kidney disease progression in the Indian CKD (ICKD) cohort: a prospective multicenter study
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Journal Article
Abstract
Background: Circulating levels of fibroblast growth factor 23 (FGF23) increase early in chronic kidney disease and are associated with a faster progression and increased mortality. However, evidence from South Asia is limited. We investigated the association between baseline intact FGF23 levels and adverse kidney outcomes in the ICKD cohort.
Methods: A prospective cohort of adult participants with mild to moderate CKD enrolled at 11 Indian hospitals was included if baseline FGF-23 levels were available. Plasma iFGF-23 was measured using a two-site ELISA. The primary endpoint was major adverse kidney events (MAKE: a composite of kidney failure, ≥50% decline in eGFR, or kidney death). Secondary endpoints included individual MAKE components, all-cause mortality, and cardiovascular mortality. Cox proportional hazards models were used to evaluate the associations between iFGF23 and time-to-event outcomes.
Results: A total of 602 participants were followed up for a median duration of 5.3 years. MAKE developed in 266 (49.3%) participants; 223 (41.3%) progressed to kidney failure; 211 (43.5%) reached ≥50% eGFR decline; and 66 (11.0%) died. iFGF23 was significantly associated with MAKE (SHR 1.23, 95% CI 1.02–1.47, p = 0.027), kidney failure (SHR 1.28, 95% CI 1.04–1.58, p = 0.02), and all-cause mortality (HR 1.39, 95% CI 1.05–1.83, p = 0.02) in unadjusted and age- and sex-adjusted Cox proportional hazards models. However, in the fully adjusted model with clinical variables, none of the associations remained statistically significant.
Conclusion: In this prospective cohort of Indian CKD patients, iFGF23 levels did not provide independent prognostic information after accounting for established risk factors. Routine iFGF23 testing has limited incremental prognostic value in this setting.
Methods: A prospective cohort of adult participants with mild to moderate CKD enrolled at 11 Indian hospitals was included if baseline FGF-23 levels were available. Plasma iFGF-23 was measured using a two-site ELISA. The primary endpoint was major adverse kidney events (MAKE: a composite of kidney failure, ≥50% decline in eGFR, or kidney death). Secondary endpoints included individual MAKE components, all-cause mortality, and cardiovascular mortality. Cox proportional hazards models were used to evaluate the associations between iFGF23 and time-to-event outcomes.
Results: A total of 602 participants were followed up for a median duration of 5.3 years. MAKE developed in 266 (49.3%) participants; 223 (41.3%) progressed to kidney failure; 211 (43.5%) reached ≥50% eGFR decline; and 66 (11.0%) died. iFGF23 was significantly associated with MAKE (SHR 1.23, 95% CI 1.02–1.47, p = 0.027), kidney failure (SHR 1.28, 95% CI 1.04–1.58, p = 0.02), and all-cause mortality (HR 1.39, 95% CI 1.05–1.83, p = 0.02) in unadjusted and age- and sex-adjusted Cox proportional hazards models. However, in the fully adjusted model with clinical variables, none of the associations remained statistically significant.
Conclusion: In this prospective cohort of Indian CKD patients, iFGF23 levels did not provide independent prognostic information after accounting for established risk factors. Routine iFGF23 testing has limited incremental prognostic value in this setting.
Date Issued
2026-01-05
Date Acceptance
2025-12-02
Citation
Frontiers in Medicine, 2026, 12
ISSN
2296-858X
Publisher
Frontiers Media S.A.
Journal / Book Title
Frontiers in Medicine
Volume
12
Copyright Statement
© 2026 Kamboj, Yadav, Rastogi, Ghosh, Sharma, Jain, Kumar, Jha and Indian Chronic Kidney Disease Study Network. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Published
Article Number
1707350
Date Publish Online
2026-01-05