Metabolic acidosis may increase fibroblast growth factor-23 and cardiovascular mortality in the community

The Authors Reply

“…To the Editor: Perkovic et al 1 suggest in their post hoc analysis that the number needed to treat (NNT) to prevent one end-stage renal disease (ESRD) over 5 years goes down as more markers of renal injury appear in a diabetic patient.…”

“…To the Editor: Thank you for the excellent study on fibroblast growth factor-23 (FGF23) and cardiovascular mortality by Ärnlöv et al 1 The authors demonstrated an interesting association between higher FGF23 and increased risk of all-cause and cardiovascular mortality in the community. However, an interesting topic that the authors did not mention about was the degree of metabolic acidosis in the study population.…”

“…The Authors Reply: We thank Dr Cheungpasitporn and coworkers for the interesting comment regarding whether metabolic acidosis stimulates fibroblast growth factor-23 (FGF23) expression in early chronic kidney disease (CKD) and whether it can be targeted therapeutically to alleviate cardiovascular risk. 1 The authors touch on a central issue in the field of FGF23 and CKD, i.e., what are the principal drivers for the initial onset of FGF23 dysregulation that appears intimately connected with adverse cardiovascular outcomes? Several mechanisms have been proposed, including increased calcium/phosphorous load, reduced Klotho level secondary to the uremic phenotype, disturbed osteocyte biology, and possibly other factors including metabolic acidosis.…”