Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO 80045, USA.
J Am Soc Nephrol. 2011 Oct;22(10):1913-22. doi: 10.1681/ASN.2010121224. Epub 2011 Sep 7.
Concentrations of the phosphate-regulating hormone fibroblast growth factor-23 (FGF-23) are elevated in patients with chronic kidney disease (CKD), but whether higher plasma FGF-23 concentrations associate with all-cause mortality, cardiovascular events, or initiation of chronic dialysis is not completely understood. Here, we measured FGF-23 concentration in stored plasma samples from 1099 patients with advanced CKD who participated in The Homocysteine in Kidney and End Stage Renal Disease study. Mean serum phosphorus concentration was 4.3 mg/dl, median FGF-23 concentration was 392 RU/ml, and mean GFR was 18 ml/min/1.73 m(2). During a median follow-up of 2.9 yr, 453 (41%) patients died from any cause, 215 (20%) had a cardiovascular event, and 615 (56%) initiated chronic dialysis. Compared with the lowest quartile of FGF-23, each subsequent quartile associated with a progressively higher risk for death, adjusted for confounders (HR [95% CI] of 1.24 [0.91 to 1.69], 1.76 [1.28 to 2.44], and 2.17 [1.56 to 3.08] for the second through fourth quartiles, respectively). In addition, compared with the lowest quartile, the two highest quartiles of FGF-23 also associated with a significantly elevated risk for cardiovascular events and initiation of chronic dialysis. In conclusion, in advanced CKD, FGF-23 strongly and independently associates with all-cause mortality, cardiovascular events, and initiation of chronic dialysis.
在慢性肾脏病（CKD）患者中，磷酸盐调节激素成纤维细胞生长因子 23（FGF-23）的浓度升高，但更高的血浆 FGF-23 浓度是否与全因死亡率、心血管事件或开始慢性透析有关尚不完全清楚。在这里，我们测量了参加同型半胱氨酸在肾脏病和终末期肾病研究的 1099 名晚期 CKD 患者的储存血浆样本中的 FGF-23 浓度。平均血清磷浓度为 4.3mg/dl，中位数 FGF-23 浓度为 392RU/ml，平均肾小球滤过率为 18ml/min/1.73m(2)。在中位随访 2.9 年后，453 名（41%）患者因任何原因死亡，215 名（20%）发生心血管事件，615 名（56%）开始慢性透析。与 FGF-23 的最低四分位数相比，每个后续四分位数的死亡风险逐渐增加，调整混杂因素后（第二至第四四分位数的调整 HR [95%CI]分别为 1.24 [0.91 至 1.69]、1.76 [1.28 至 2.44]和 2.17 [1.56 至 3.08]）。此外，与最低四分位数相比，FGF-23 的两个最高四分位数也与心血管事件和开始慢性透析的风险显著增加相关。总之，在晚期 CKD 中，FGF-23 与全因死亡率、心血管事件和开始慢性透析密切相关且独立相关。
