Figure 4.

Elevated fibroblast growth factor-23 (FGF-23) is a powerful risk factor for death that surpasses elevated serum phosphate. (A) In a prospective cohort study, higher levels of FGF-23 on the first day of long-term outpatient hemodialysis were independently associated with increased risk of 1-year mortality on dialysis. The results were noteworthy for the large magnitude of effect, the monotonic graded effect across the range of baseline FGF-23 levels, and the minimal amount of confounding that is indicated by qualitatively similar results across the three different multivariable modeling strategies. Adapted from reference 48 with permission from the Massachusetts Medical Society. (B) As a biomarker of risk of death on dialysis, the strong monotonic effect of elevated FGF-23 vastly overshadowed the effect of higher serum phosphate, as shown by the corresponding odds ratios for each that were derived from the fully adjusted multivariable model. Adapted from reference 48 with permission from the Massachusetts Medical Society.