Post Adrian, Groothof Dion, Schutten Joëlle C, Kelly Dylan, Swarte J Casper, Flores-Guerrero Jose L, van der Veen Yvonne, Kema Ido P, Ozyilmaz Akin, Enya Ayano, Westerhuis Ralf, Bakker Stephan J L, Franssen Casper F M
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Clin Nutr. 2021 Jun;40(6):4216-4224. doi: 10.1016/j.clnu.2021.01.036. Epub 2021 Feb 3.
Protein energy wasting (PEW) is the most important risk factor for morbidity and mortality in hemodialysis patients. Inadequate dietary protein intake is a frequent cause of PEW. Recent studies have identified fibroblast growth factor 21 (FGF21) as an endocrine protein sensor. This study aims to investigate the potential of FGF21 as a biomarker for protein intake and PEW and to investigate intradialytic FGF21 changes.
Plasma FGF21 was measured using an enzyme-linked immunoassay. Complete intradialytic dialysate and interdialytic urinary collections were used to calculate 24-h urea excretion and protein intake. Muscle mass was assessed using the creatinine excretion rate and fatigue was assessed using the Short Form 36 and the Checklist Individual Strength.
Out of 59 hemodialysis patients (65 ± 15 years, 63% male), 39 patients had a low protein intake, defined as a protein intake less than 0.9 g/kg/24-h. Patients with a low protein intake had nearly twofold higher plasma FGF21 compared to those with an adequate protein intake (FGF21 1370 [795-4034] pg/mL versus 709 [405-1077] pg/mL;P < 0.001). Higher plasma FGF21 was associated with higher odds of low protein intake (Odds Ratio: 3.18 [1.62-7.95] per doubling of FGF21; P = 0.004), independent of potential confounders. Higher plasma FGF21 was also associated with lower muscle mass (std β: -0.34 [-0.59;-0.09];P = 0.009), lower vitality (std β: -0.30 [-0.55;-0.05];P = 0.02), and more fatigue (std β: 0.32 [0.07;0.57];P = 0.01). During hemodialysis plasma FGF21 increased by 354 [71-570] pg/mL, corresponding to a 29% increase.
Higher plasma FGF21 is associated with higher odds of low protein intake in hemodialysis patients. Secondarily, plasma FGF21 is also associated with lower muscle mass, less vitality, and more fatigue. Lastly, there is an intradialytic increase in plasma FGF21. FGF21 could be a valuable marker allowing for objective assessment of PEW.
蛋白质能量消耗（PEW）是血液透析患者发病和死亡的最重要风险因素。饮食中蛋白质摄入不足是PEW的常见原因。最近的研究已将成纤维细胞生长因子21（FGF21）确定为一种内分泌蛋白传感器。本研究旨在探讨FGF21作为蛋白质摄入和PEW生物标志物的潜力，并研究透析期间FGF21的变化。
采用酶联免疫吸附测定法测定血浆FGF21。使用透析期间完整的透析液和透析间期尿液收集量来计算24小时尿素排泄量和蛋白质摄入量。使用肌酐排泄率评估肌肉质量，并使用简明健康调查问卷36项版本和个体力量检查表评估疲劳程度。
在59例血液透析患者（65±15岁，63%为男性）中，39例患者蛋白质摄入量低，定义为蛋白质摄入量低于0.9 g/kg/24小时。蛋白质摄入量低的患者血浆FGF21水平比蛋白质摄入量充足的患者高出近两倍（FGF21为1370[795 - 4034] pg/mL，而后者为709[405 - 1077] pg/mL；P<0.001）。血浆FGF21水平较高与蛋白质摄入量低的几率较高相关（优势比：FGF21每增加一倍为3.18[1.62 - 7.95]；P = 0.004），不受潜在混杂因素影响。血浆FGF21水平较高还与较低的肌肉质量（标准化β：-0.34[-0.59；-0.09]；P = 0.009）、较低的活力（标准化β：-0.30[-0.55；-0.05]；P = 0.02）和更多的疲劳感（标准化β：0.32[0.07；0.57]；P = 0.01）相关。血液透析期间，血浆FGF21升高了354[71 - 570] pg/mL，相当于增加了29%。
血液透析患者血浆FGF21水平较高与蛋白质摄入量低的几率较高相关。其次，血浆FGF21还与较低的肌肉质量、较少的活力和更多的疲劳感相关。最后，血液透析期间血浆FGF21会升高。FGF21可能是一种有价值的标志物，可用于客观评估PEW。
