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Results

Mean estimated GFR (eGFR) was 35 ml/min per 1.73 m 2. At enrollment, the increase in intact FGF23 with decreasing eGFR was the earliest among changes in MBD-related factors, followed by 1, 25-dihydroxyvitamin D decrease, parathyroid hormone increase, and phosphate increase. During a median duration of 4.4 years, 213 patients reached the endpoint. In a multivariable Cox model, high FGF23 and low 25-hydroxyvitamin D (25D) levels were the only MBD-related factors associated with a higher risk of renal endpoint (adjusted hazard ratio [95% confidence interval] per unit change of log FGF23 and 10 ng/ml of 25D: 1.83 [1.28–2.61] and 0.61 [0.41–0.90], respectively). There was no significant interaction between 25D and FGF23 (P= 0.11). Active vitamin D therapy, serum phosphate, 1, 25-dihydroxyvitamin D, and parathyroid hormone levels were not related to the renal endpoint. Treating death as a …