Role of fibroblast growth factor 23 in predicting CKD progression and prognosis: a systematic review and meta-analysis

Abstract

Background and Objectives Chronic kidney disease (CKD) affects 10% of the global population. This meta-analysis evaluated fibroblast growth factor 23 (FGF-23) as a prognostic biomarker for CKD progression, kidney failure, cardiovascular events, and mortality. Materials and Methods We systematically searched PubMed, Cochrane, Embase, and SCOPUS from inception through January 2025. Twelve prospective cohort studies enrolling 21,042 pre-dialysis adult patients with CKD stages 1–5 were included; outcomes encompassed kidney function decline, progression to kidney failure, cardiovascular events, heart failure, and all-cause mortality. Results Elevated fibroblast growth factor (FGF)-23 levels were associated with lower estimated glomerular filtration rate (eGFR) (mean difference: 17.83 mL/min/1.73m2). In mild-moderate CKD, each 10 relative units (RU)/mL FGF-23 increase conferred 1.7% higher kidney failure risk (hazard ratio (HR) 1.01, 95% confidence interval (CI) [1.01–1.02]). In advanced CKD, highest vs. lowest FGF-23 quartile showed 2.32-fold increased kidney failure risk (95% CI [1.80–2.98]). High FGF-23 associated with increased cardiovascular events (HR 1.72, 95% CI [1.34–2.20]), heart failure (HR 2.14, 95% CI [1.53–3.00]), and all-cause mortality (HR 1.61, 95% CI [1.40–1.87]). Conclusions FGF-23 is a significant prognostic biomarker predicting CKD progression, cardiovascular events, and mortality, supporting its utility in risk stratification and personalized management. Incorporating FGF-23 measurement into routine CKD care may enable earlier risk stratification and more targeted clinical interventions.