Hemodialysis is associated with higher serum FGF23 level when compared with peritoneal dialysis

Bi, Shu-Hong; Liang, Yaoxian; Cheng, Lei; Wang, Yue; Han, Qinfeng; Zhang, Aihua

doi:10.1007/s11255-017-1605-z

Cited by 12 publications

(4 citation statements)

References 19 publications

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“…20 Previous studies have shown that FGF23 expression positively correlates with serum concentrations of phosphate and calcium in patients undergoing HD or PD. [21][22][23] The present findings are consistent with those of previous studies, showing that serum phosphorus is an independent predictor of FGF23 concentration, which can be explained by that high phosphorus concentrations affecting the secretion of FGF23. 5 In addition to its effects on CKD-MBD, FGF23 has been linked to iron metabolism, erythrocyte production and differentiation.…”

Section: Discussionsupporting

confidence: 93%

Serum fibroblast growth factor 23 concentration and the risk of mortality in patients undergoing peritoneal dialysis

Zhong,

Feng,

et al. 2024

Perit Dial Int

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Background: Fibroblast growth factor 23 (FGF23) is a phosphate-regulating hormone that is secreted in large amounts early in chronic kidney disease. In this cohort, we aimed to investigate the association between serum FGF23 concentration and mortality in patients undergoing peritoneal dialysis (PD). Methods: Serum FGF23 level was determined by enzyme-linked immunosorbent assay (ELISA) in a large 15-year prospective cohort study of PD patients with stored serum samples at baseline. Kaplan–Meier survival curves and Cox proportional hazards models were performed to characterise the relationship of FGF23 with mortality. Results: A total of 737 incident PD patients were analysed. The baseline median FGF23 concentration was 683.2 (518.5–896.2) pg/mL. Age, serum phosphorus, high-density lipoprotein cholesterol and high-sensitivity C-reactive protein were independently correlated with serum FGF23 concentration. During a median follow-up of 66.7 (41.1–95.4) months, 171 of the 737 participants (23.2%) died, including 84 (49.1%) cardiovascular disease-related and 50 (29.2%) infection-related deaths. Multivariable Cox regression analysis showed that the adjusted hazard ratios of the highest tertile of serum FGF23 compared with those in the lowest tertile were 1.36 (95% confidence interval (CI): 0.89–2.07; p = 0.154), 0.75 (95% CI: 0.40–1.38; p = 0.353) and 2.66 (95% CI: 1.15–6.15; p = 0.022) for all-cause, cardiovascular disease-related and infection-related mortality, respectively. Conclusion: High serum FGF23 concentration is associated with a higher risk of infection-related death for incident PD patients.

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Section: Discussionsupporting

confidence: 93%

Serum fibroblast growth factor 23 concentration and the risk of mortality in patients undergoing peritoneal dialysis

Zhong,

Feng,

et al. 2024

Perit Dial Int

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“…In fact, it has been shown that hemodialysis is associated with higher serum FGF-23 levels when compared with PD. [32] It is thought that the lower removal of FGF-23 causes the higher levels in hemodialysis. In fact, our group has previously shown increased levels of FGF-23 in the dialysis fluid after a 4-hour dwell in six patients [16].…”

Section: Discussionmentioning

confidence: 99%

Baseline carotid intima‐media thickness is associated with cardiovascular morbidity and mortality in peritoneal dialysis patients

et al. 2021

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Carotid intima-media thickness (CIMT) is an early marker of atherosclerosis and is increased in peritoneal dialysis (PD) patients. Association of CIMT with cardiovascular disease (CVD) or mortality is less clear. Fibroblast growth factor-23 (FGF-23) is a hormone associated with vascular calcification, atherosclerosis, and mortality in the hemodialysis population. We investigated whether baseline CIMT and FGF-23 are associated with CVD and mortality in PD patients. Fifty-five PD patients were included. CVD was defined as ischemic heart disease, stroke, or peripheral artery disease. Intact FGF-23 was measured in plasma. CIMT was measured by ultrasonography. Twenty-one patients developed CVD and 12 died over 47.1 ± 33.8 months. Patients with CVD were older (55.9 ± 10.5 vs. 42.5 ± 12.9 years, P < .01), had lower albumin (3.8 ± 0.5 vs. 4.2 ± 0.3 g/dL, P < .01) and higher CIMT (0.87 ± 0.22 vs. 0.61 ± 0.11 mm, P < .01). Patients with mortality were also older (53.5 ± 11.5 vs. 45.8 ± 13.8 years, P = .05), had lower albumin (3.7 ± 0.6 vs. 4.1 ± 0.3 g/dL, P < .01), higher CRP (15.0 ± 8.5 vs. 7.6 ± 8.4 mg/L, P < .01) and CIMT (0.9 ± 0.3 vs. 0.6 ± 0.1 mm, P < .01). Albumin and CIMT were associated with CVD and CIMT > 0.75 mm was associated with cardiovascular mortality. FGF-23 did not show any correlations. CIMT at baseline is associated with CVD and mortality in PD patients.

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“…Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that regulates renal phosphate reabsorption and vitamin D synthesis in renal proximal tubules [1]. Importantly, FGF23 levels start increasing early in the course of chronic kidney disease (CKD) and reach extremely high levels in patients on dialysis [2][3][4][5]. Serum phosphate (iP), calcium, and intact parathyroid hormone (iPTH) are proposed to regulate FGF23 levels in uremic patients on maintenance hemodialysis [6], and current data suggest higher circulating levels of FGF23 are associated with mortality [7][8][9][10][11], especially cardiovascular mortality [10,[12][13][14][15] due to vascular calcification [16][17][18][19] or left ventricular hypertrophy (LVH) [20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Fibroblast growth factor 23 (FGF23) level is associated with ultrafiltration rate in patients on hemodialysis

et al. 2020

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Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that regulates renal phosphate reabsorption and vitamin D synthesis in renal proximal tubules. High circulating FGF23 levels are associated with increased mortality in patients with chronic kidney disease and those on dialysis. Current data also suggest higher circulating levels of FGF23 are associated with cardiovascular mortality, vascular calcification, and left ventricular hypertrophy; however, evidence on the role of FGF23 in patients on dialysis is incomplete, and some of the data, especially those on cardiovascular disease (CVD), are controversial. This study aimed to evaluate factors associated with FGF23 in hemodialysis patients with or without CVD. Randomly selected 76 patients on maintenance hemodialysis at a single hemodialysis center were enrolled. After the exclusion of eight patients with extremely outlying FGF23 levels, 68 patients, including 48 males and 46 patients with a CVD history, were included in the study. The mean age was 64.4 ± 12.1 years, and the mean dialysis duration was 12.7 ± 7.1 years. Dialysis duration, time-averaged concentration of urea (TAC-urea), ultrafiltration rate (UFR), blood pressure during hemodialysis session, laboratory data, and echocardiographic parameters including interventricular septum thickness (IVST), left ventricular mass indices (LVMI), and ejection fraction were included in univariate and multivariate analyses. The median lgFGF23 levels in the overall cohort and in those with and without CVD were 2.14 (interquartile range, IQR − 0.43 to − 4.23), 2.01 (− 0.52 to 4.12), and 2.59 (0.07 to 4.32), respectively, and there was no difference between the patients with and without CVD (p = 0.14). The univariate analysis revealed that FGF23 was significantly associated with age (r = − 0.12, p < 0.01), duration of hemodialysis (r = − 0.11, p < 0.01), TAC-urea (r = 0.29, p = 0.01), UFR (r = 0.26, p = 0.04), alkaline phosphatase (ALP; r = − 0.27, p = 0.03), corrected serum calcium (cCa; r = 0.32, p < 0.01), serum phosphate (iP, r = 0.57, p < 0.01), intact parathyroid hormone (iPTH; r = 0.38, p < 0.01), IVST (r = 0.30, p = 0.01), and LVMI (r = 0.26, p = 0.04). In multivariate regression analysis, FGF23 was significantly associated with cCa (F = 25.6, p < 0.01), iP (F = 22.5, p < 0.01), iPTH (F = 19.2, p < 0.01), ALP (F = 5.34, p = 0.03), and UFR (F = 3.94, p = 0.05). In addition, the univariate analysis after the categorization of patients according to CVD indicated that FGF23 was significantly associated with cCa (r = 0.34, p = 0.02), iP (r = 0.41, p < 0.01), iPTH (r = 0.39, p = 0.01), and TAC-urea (r = 0.45, p < 0.01) in patients with CVD, whereas only IVST (r = 0.53, p = 0.04) was associated with FGF23 in those without CVD. FGF23 levels in hemodialysis patients were extremely high and associated not only with mineral bone disease-related factors but also with UFR. Additionally, dialysis efficacy might be associated with lower FGF23 levels in patients with CVD.

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Hemodialysis is associated with higher serum FGF23 level when compared with peritoneal dialysis

Cited by 12 publications

References 19 publications

Serum fibroblast growth factor 23 concentration and the risk of mortality in patients undergoing peritoneal dialysis

Serum fibroblast growth factor 23 concentration and the risk of mortality in patients undergoing peritoneal dialysis

Baseline carotid intima‐media thickness is associated with cardiovascular morbidity and mortality in peritoneal dialysis patients

Fibroblast growth factor 23 (FGF23) level is associated with ultrafiltration rate in patients on hemodialysis

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