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

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.