Department of Nephrology, School of Medicine, Kasr El-Aini School of Medicine, Cairo University, Cairo, Egypt.
Nephrol Dial Transplant. 2010 Aug;25(8):2679-85. doi: 10.1093/ndt/gfq089. Epub 2010 Feb 22.
Vascular calcification has detrimental consequences on chronic kidney disease (CKD) patients, yet its pathogenesis is not fully understood. Fibroblast growth factor-23 (FGF-23) is involved in the regulation of mineral metabolism which may in turn affect vascular calcification. Data on the relationship between FGF-23 and peripheral vascular calcification, using conventional radiographs, are conflicting, and less is known about its relation to aortic calcification. We conducted this study to investigate the relationship between FGF-23 and aortic calcification in a standard haemodialysis setting.
The study included 65 haemodialysis patients (46 prevalent and 19 incident) on a three times 4-h dialysis schedule as well as 15 controls. Those with diabetes, oral anticoagulation or parathyroidectomy were excluded. Intact FGF-23, parathormone, lipids, calcium and phosphorus were measured. Aortic calcification index (ACI) was assessed by a non-contrast computerized tomography (CT) of the abdominal aorta.
FGF-23 levels were higher among haemodialysis patients (4681.3 +/- 3906.1 pg/mL) compared to controls (98.2 +/- 51.9 pg/mL), P = 0.005. ACI was higher in haemodialysis patients (14.1 +/- 12) than controls (3.2 +/- 3.6), P = 0.009. FGF-23 (P < 0.0001) and systolic blood pressure (BP) (P < 0.0001) were independently related to ACI in stepwise multiple regression analysis of pooled analysis of haemodialysis patients, R(2) = 0.476; in subgroup analysis, the independent factors relating to ACI among prevalent dialysis patients were systolic BP (P < 0.0001), FGF-23 (P = 0.002) and age (P = 0.012), R(2)=0.48; whereas in incident patients, only FGF-23 was associated with ACI (P = 0.007), R(2) = 0.37.
In haemodialysis patients, FGF-23 and ACI were significantly increased, and FGF-23 was independently associated with aortic calcification.
血管钙化对慢性肾脏病（CKD）患者有不利影响，但其发病机制尚不完全清楚。成纤维细胞生长因子 23（FGF-23）参与矿物质代谢的调节，这可能反过来影响血管钙化。使用常规射线照相术获得的关于 FGF-23 与周围血管钙化之间关系的数据存在冲突，而关于其与主动脉钙化之间关系的了解则较少。我们进行了这项研究，以在标准血液透析环境中研究 FGF-23 与主动脉钙化之间的关系。
该研究纳入了 65 名接受三次 4 小时透析方案的血液透析患者（46 名是现患患者，19 名是新发病例）以及 15 名对照者。排除了患有糖尿病、口服抗凝剂或甲状旁腺切除术的患者。测量了完整的 FGF-23、甲状旁腺激素、血脂、钙和磷。通过腹部主动脉的非对比计算机断层扫描（CT）评估主动脉钙化指数（ACI）。
与对照组（98.2±51.9pg/ml）相比，血液透析患者的 FGF-23 水平更高（4681.3±3906.1pg/ml），P=0.005。血液透析患者的 ACI 较高（14.1±12），对照组为（3.2±3.6），P=0.009。在血液透析患者的逐步多元回归分析的 pooled 分析中，FGF-23（P＜0.0001）和收缩压（BP）（P＜0.0001）是 ACI 的独立相关因素，R²=0.476；在亚组分析中，现患透析患者中与 ACI 相关的独立因素是收缩压（P＜0.0001）、FGF-23（P=0.002）和年龄（P=0.012），R²=0.48；而在新发病例中，只有 FGF-23 与 ACI 相关（P=0.007），R²=0.37。
在血液透析患者中，FGF-23 和 ACI 显著增加，FGF-23 与主动脉钙化独立相关。
