Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Int Urol Nephrol. 2014 Jan;46(1):99-106. doi: 10.1007/s11255-013-0386-2. Epub 2013 Jan 25.
Fibroblast growth factor-23 (FGF23) is a phosphate-regulating hormone and is found to be markedly increased in patients with chronic kidney disease. The aim of the present study was to evaluate the relationship between serum FGF23 levels and mortality, including the impact of gender and cardiovascular disease (CVD), in a Japanese cohort of chronic hemodialysis (HD) patients.
Ninety-two maintenance dialysis patients (58 men; mean age 60.3 years) were included. Serum intact FGF23, calcium, phosphate, albumin, intact parathyroid hormone (PTH), and C-reactive protein were measured at baseline. CVD was defined as clinical symptoms and/or a history of CVD.
During a median follow-up time of 53.2 months, 24 patients (26 %) died. Serum FGF23 levels were positively correlated with serum levels of calcium (r = 0.5433, P < 0.0001), phosphate (r = 0.5048, P < 0.0001), calcium × phosphate product (r = 0.6801, P < 0.0001), and intact PTH (r = 0.2710, P = 0.0090) (r = 0.27, P < 0.0001). In Cox proportional hazard models, serum FGF23 level was not associated with increased mortality risk, neither in crude nor in multivariate-adjusted models. However, in a subgroup analysis of women with previous CVD, serum FGF23 level above median was associated with higher cardiovascular event risk in crude models (hazard ratio 9.52, 95 % confidence interval 1.56-86.11, P = 0.0129). Kaplan-Meier analysis stratifying for the presence of CVD demonstrated a significant higher mortality risk in patients with history of CVD and higher serum FGF23 levels (P < 0.0001).
Serum FGF23 level was not associated with increased mortality risk in this cohort of prevalent HD patients. These results suggest that the impact of FGF23 on mortality may be modified by gender and previous CVD and is blunted in the grade of hyperphosphatemia.
成纤维细胞生长因子 23（FGF23）是一种调节磷的激素，在慢性肾脏病患者中明显升高。本研究的目的是评估日本慢性血液透析（HD）患者群体中血清 FGF23 水平与死亡率之间的关系，包括性别和心血管疾病（CVD）的影响。
纳入 92 名维持性透析患者（58 名男性；平均年龄 60.3 岁）。在基线时测量血清完整 FGF23、钙、磷、白蛋白、完整甲状旁腺激素（PTH）和 C 反应蛋白。CVD 定义为临床症状和/或 CVD 病史。
在中位随访时间为 53.2 个月期间，有 24 名患者（26%）死亡。血清 FGF23 水平与血清钙（r = 0.5433，P < 0.0001）、磷（r = 0.5048，P < 0.0001）、钙×磷乘积（r = 0.6801，P < 0.0001）和完整 PTH（r = 0.2710，P = 0.0090）呈正相关（r = 0.27，P < 0.0001）。在 Cox 比例风险模型中，血清 FGF23 水平与死亡率增加无关，无论是在未调整还是多变量调整模型中。然而，在有 CVD 病史的女性亚组分析中，在粗模型中，血清 FGF23 水平高于中位数与心血管事件风险增加相关（危险比 9.52，95%置信区间 1.56-86.11，P = 0.0129）。对 CVD 存在情况进行分层的 Kaplan-Meier 分析表明，有 CVD 病史且血清 FGF23 水平较高的患者死亡率显著升高（P < 0.0001）。
在本队列的流行 HD 患者中，血清 FGF23 水平与死亡率增加无关。这些结果表明，FGF23 对死亡率的影响可能受到性别和以前 CVD 的影响，并在高磷血症的程度上减弱。
