Effect of serum FGF‐23, MGP and fetuin‐A on calcium‐phosphate metabolism in maintenance hemodialysis patients

Abstract

This study was aimed to explore the role of serum fibroblast growth factor (FGF)-23, matrix Gla protein (MGP) and fetuin-A in the calcium-phosphate metabolism and their predicting value in coronary artery calcification in maintenance hemodialysis (MHD) patients. This study included 64 patients who receive hemodialysis in our hospital. The serum FGF-23, MGP and fetuin-A were analyzed by enzyme-linked immunosorbent assay (ELlSA). Coronary artery calcification score (CACS) was evaluated by coronary artery computed tomography scan. The 64 patients (30 males, 34 females, 60.6 ± 11.3 years of age) received an average dialysis vintage of 6.88 ± 2.94 years. We divided the CACS into three levels, and 13 (20.31%), 16 (25%), and 35 (54.69%) exhibited a CACS of 0-100, 100-400, and >400, respectively. Dialysis vintage, serum FGF-23, fetuin-A, phosphorus and high-density lipoprotein-C levels were identified as independent variables of CACS by stepwise multiple regression analysis. The area under receiver operating characteristic curve indicated that serum FGF-23 and fetuin-A were useful for identifying CAC in MHD patients. The cut-off value corresponding to the highest Youden's index was serum FGF-23 ≥ 256 pg/mL and fetuin-A ≤ 85 μg/mL, which was defined as the optimal predictors of CAC. Different combinations of serum FGF-23 and fetuin-A in parallel or in series effectively boosted the identification of CAC. The incidence of CAC is high in MHD patients. Serum FGF-23 and fetuin-A levels are closely correlated with CAC.

Associations of vascular calcification, calcium phosphate disturbances, FGF 23 and Matrix Gla protein with mortality of hemodialysis patients: one center cohort study

“…FGF 23 is known to be elevated in patients with chronic kidney disease and is strongly associated with mortality and cardiovascular diseases (19,(35)(36)(37) . In our study, we found relatively low values of FGF23 as compared to Xiao et al study (32) and this probably needs more detailed investigation to clarify the reasons. Our study failed to show statistically significant differences in FGF 23 levels in patients with different VC scores.…”

“…In others, markedly elevated plasma levels of MGP were found as compared to healthy controls probably due to impaired MGP activation, increased production and release as well as decreased clearance of MGP in HD patients (17). In our study, the levels of MGP were higher compared to those presented in the study of Xiao et al (32) though both studies evaluated overall serum MGP. We did not find any significant difference in MGP levels of patients with different VC severity.…”

“…We did not find any significant difference in MGP levels of patients with different VC severity. It is demonstrated in the literature that higher FGF 23 levels and lower uncarboxylated MGP levels are associated with mortality and cardiovascular events in patients without end-stage renal disease (32). We also expected to find this type of associations in HD patients, but our study did not succeed to prove it and we can only speculate about the underlying mechanism of these observations.…”

“…Data on the role of MGP changes in a uremic state is still inconclusive. Several studies have reported significantly lower serum levels of uncarboxylated MGP in dialysis patients than healthy controls (32). In others, markedly elevated plasma levels of MGP were found as compared to healthy controls probably due to impaired MGP activation, increased production and release as well as decreased clearance of MGP in HD patients (17).…”

Is Matrix Gla Protein Associated with Vascular Calcification? A Systematic Review

“…In total, 13 studies were rated as having a high risk of bias [ 20 , 23 , 24 , 25 , 26 , 28 , 29 , 32 , 33 , 37 , 39 , 40 , 41 , 43 ]. Three studies were rated as having a moderate risk [ 30 , 31 , 34 ] of bias and 12 were rated as having a low risk of bias [ 14 , 15 , 17 , 18 , 27 , 35 , 36 , 38 , 42 , 44 , 45 ].…”