الفهرس 
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Abstract
CKD is a worldwide public problem. It is associated with an increased risk of cardiovascular disease, premature mortality and decreased quality of life.
Fibroblast growth factor 23 (FGF23) has emerged as a central player of disordered mineral metabolism in patients with chronic kidney disease (CKD).
The aim of the present study is to investigate whether serum . FGF23 level is modulated by renal function changes and to examine it’s utility as a new biomarker for diagnosis of CKD specially in the early stage.
This study involved 73 patients suffering from CKD and they were divided according to eGFR in to five subgroups; ten patients as subgroup 1, twenty patients as subgroup 2,twenty patients as subgroup 3, ten patients as subgroup 4, thirteen patients as subgroup 5 and fifteen apparently healthy subjects served as a control group.
All individuals were subjected to detailed history taking, full clinical examination, weight measurement and laboratory investigations in the form of Hb, serum urea, creatinine, Ca, phosphorus, albumin, uric acid, eGFR and serum FGF23 .
The results of the current study showed:
• As regard the demographic criteria :
There was statistically non-significant difference between CKD patients and control group as regard weight, age and gender (p>0.05).
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• As regard the biochemical markers:
- The mean difference between the whole studied subgroups of biochemical markers: serum albumin was statistically significant (p<0.05) while, serum Ca and serum Po4 were highly significant (p < 0.001)
- The mean difference of serum urea, creatinine, uric acid and eGFR were highly significant between all studied subgroups (p<0.01).
• As regard the serum FG23 protein level:
The mean FGF23 protein levels were statistically lower in controls compared to CKD patients. Post hoc test revealed that there were highly statistical significant differences between controls and all other subgroups 1 ,2 ,3 ,4 ,5 (P < 0.001).Also, there were highly significant differences between subgroup 1 and all others subgroups 2 ,3 ,4 ,5 (P < 0.001). As well as, there were highly statistical significant differences between subgroup 2 and all other subgroups 3, 4, 5 (P < 0.001). Meanwhile, there were highly statistical significant differences between subgroup 3 and all other subgroups 4, 5 (P <0.001). There was a highly statistical significant difference between subgroup 4 and subgroup 5 (P< 0.001).
• As regard correlation between FGF23 protein and other studied parameters:
There were significant positive correlations between FGF23 protein and Hb, eGFR. However, there were significant negative correlations between serum FGF23 protein and urea, creatinine and uric acid in total patients.
• As regard ROC curve
- Receiver operating characteristic (ROC) graph revealed that the best cutoff level of serum FGF23 protein to differentiate between controls and total patients was32.5 ng/l, at this level, the diagnostic sensitivity was 100%, the specificity 100%, the positive predictive value 100% and the negative predictive value 100%.
- The best cutoff level of serum FGF23 of protein to differentiate between controls and subgroup 1 was 32.50 ng/l, at this level, the diagnostic sensitivity was 100%, the specificity 90%, the positive predictive value 100% and the negative predictive value 100%.
- The best cutoff level of serum FGF23 protein to differentiate between subgroup 1 and subgroup 2 was 72.5 ng/l, at this level, the diagnostic sensitivity was 90%, the specificity 100%, the positive predictive value 100% and the negative predictive value 83.3%.
- The best cutoff level of serum FGF 23 to differentiate between subgroup 2 and subgroup 3 was 88.7 ng/l, at this level, the diagnostic sensitivity was 90%, the specificity 75%, the positive predictive value 78.3% and the negative predictive value 88.2%.
- The best cutoff level of serum FGF23 protein to differentiate between subgroup 3 and subgroup 4 was 120 ng/l, at this level, the diagnostic sensitivity was 100%, the specificity 95%,, the positive predictive value 90.9% and the negative predictive value 100%.