Association between fibroblast growth factor 23 and coronary artery calcification in patients with chronic kidney disease: a meta-analysis

Background Coronary artery calcification (CAC) is a common cardiovascular complication in patients with chronic kidney disease (CKD). Fibroblast growth factor 23 (FGF23), a key regulator of phosphate metabolism, has been implicated in vascular calcification, but studies evaluating its association with CAC in CKD have yielded inconsistent findings. This meta-analysis aimed to evaluate the association between circulating FGF23 levels and CAC in patients with CKD. Methods PubMed, Embase, Web of Science, Wanfang, and CNKI were systematically searched for observational studies evaluating the association between circulating FGF23 levels and CAC in adult patients with CKD were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using random-effects models accounting for the influence of potential heterogeneity. Results Twelve cross-sectional studies involving 3, 466 patients with CKD were included. Elevated circulating FGF23 levels were significantly associated with a higher prevalence of CAC (OR: 2.11, 95% CI: 1.70–2.63, p  p for subgroup difference >0.05). Meta-regression analyses showed that study-level characteristics did not significantly influence the association. Conclusions Elevated circulating FGF23 levels are associated with a higher prevalence of CAC in patients with CKD. These findings suggest that elevated FGF23 levels may serve as a potential biomarker associated with vascular calcification in CKD, although prospective studies are needed to clarify causality and clinical utility. This meta-analysis was conducted in accordance with established methodological recommendations, adhering to the PRISMA 2020 guidelines (32) and the Cochrane Handbook for Systematic Reviews of Interventions (33) throughout protocol development, literature screening, data extraction, statistical synthesis, and interpretation of the findings. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420261415908.