Association of serum intact fibroblast growth factor 23 with left ventricular mass and different echocardiographic findings in patients on hemodialysis

Abstract

Objectives: To determine the association of fibroblast growth factor 23 (FGF23) with left ventricular hypertrophy (LVH) through the assessment of left ventricular (LV) mass and left ventricular mass index (LVMI) in patients on hemodialysis, this study was done. Methods: All patients on hemodialysis who are older than 18 years and in whom hemodialysis vintage was at least 6 months were enrolled. All patients were on hemodialysis thrice a week for 4 h using low-flux dialysis filters, polysulfone membranes, reverse osmosis purified water, and bicarbonate-base hemodialysis solution. The exclusion criteria were any respiratory illness or pulmonary infection, cigarette smoking, and the presence of pericarditis or pericardial effusion. Additionally, patients with a known coronary artery disease, any form of cardiac arrhythmias, any cardiomyopathy or severe valvular heart disease diagnosed by echocardiography, acute congestive heart failure (CHF), and acute myocardial infarction were not included. Echocardiography was conducted by an experienced operator for all the enrolled patients using the ACUSON SC2000™ ultrasound system transducer (Siemens), with a frequency bandwidth of: 1.5-3.5 MHz. Patients were considered to have LVH if the LVMI was greater than 134 g/m 2 for men and greater than 110 g/m 2 for women. Results: A total of 61 patients (19 female and 42 male) were enrolled to the study. Mean (± SD) age of the patients was 59.6 ± 13.1 years. The median duration of hemodialysis was 23 (range: 6-120) months. The median predialysis level of FGF23 was 1,977 pg/mL (range: 155-8,870). LVH was seen in 73.8% of the patients (n = 45) and of them 66.7% were male. There was a statistically significant direct correlation between FGF23 and left ventricle diameter in end systole (LVDs) (r = 0.29, P = 0.027). However, the association of FGF23 with LV mass, LVMI, and left ventricular ejection fraction (LVEF) was not significant. Conclusion: This study does not show the correlation between FGF23 and LV mass in stable hemodialysis patients.

Correlation of serum soluble Klotho with fibroblast growth factor 23 levels in chronic kidney disease patients; a single centre study

“…Moreover, the role of sKlotho in the development of atherosclerotic disease in dialysis patients might be overshadowed by a large amount of other pathophysiological stimuli for CVD prevalent in these patients, such as smoking, obesity, diabetes and hypertension among others (11). As reported by previous studies, our study also reported an association between FGF-23 and LV mass index (13)(14)(15). A majority of our patients had a high left ventricular mass index (mean: 122.5 ± 22.74 g/m 2 ), compared to previously established references for healthy men and women, which is not surprising in view of their CKD and elevated FGF-23 levels (16,17).…”

Meta-Analysis of the Association between Fibroblast Growth Factor 23 and Mortality and Cardiovascular Events in Hemodialysis Patients

“…In addition, FGF23 has direct cardiac and vascular poisonous [24,25], independent on α-klotho. Several clinical researches have confirmed that FGF23 had an association with left ventricular mass, ejection fraction, left ventricular end-diastolic dimension, and vascular calcification [26,27]. These factors are associated with an adverse outcome in health individuals and hemodialysis patients.…”

The anti-aging factor Klotho protects against acquired long QT syndrome induced by uremia and promoted by fibroblast growth factor 23

“…The relationship between FGF23 and the development of LVH in CKD patients has been described [ 44 ], but contradictory data has been reported in dialysis patients. Some studies described an association between FGF23 and LVH in dialysis patients [ 73 ] while others authors did not find associations between serum FGF23 levels and LVH [ 74 , 75 ]. Thus, the QT interval prolongation observed in our cohort might indeed be due to the increased levels of FGF23 in the dialysis patients, which is also experimentally supported by the increased QT interval duration observed in healthy mice after a single FGF23 injection.…”