FGF23 and Hepatic fibrosis: However, the predominance of FIB4’s direct effects supports the hypothesis that hepatic fibrosis directly compromises cardiovascular integrity through pathways like structural remodeling (e.g., arterial stiffening) and metabolic toxicity (e.g., uremic solute accumulation, FGF23 axis dysregulation), notwithstanding the partial mediation indicated by NLR.