Vascular Research Group, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK.
Department of Renal Medicine, Salford Royal Hospital, Level 2, Hope Building, Stott Lane, Salford, M6 8HD, UK.
BMC Nephrol. 2021 Oct 2;22(1):329. doi: 10.1186/s12882-021-02528-2.
Fibroblast growth factor23 (FGF23) is elevated in CKD and has been associated with outcomes such as death, cardiovascular (CV) events and progression to Renal Replacement therapy (RRT). The majority of studies have been unable to account for change in FGF23 over time and those which have demonstrate conflicting results. We performed a survival analysis looking at change in c-terminal FGF23 (cFGF23) over time to assess the relative contribution of cFGF23 to these outcomes.
We measured cFGF23 on plasma samples from 388 patients with CKD 3-5 who had serial measurements of cFGF23, with a mean of 4.2 samples per individual. We used linear regression analysis to assess the annual rate of change in cFGF23 and assessed the relationship between time-varying cFGF23 and the outcomes in a cox-regression analysis.
Across our population, median baseline eGFR was 32.3mls/min/1.73m, median baseline cFGF23 was 162 relative units/ml (RU/ml) (IQR 101-244 RU/mL). Over 70 months (IQR 53-97) median follow-up, 76 (19.6%) patients progressed to RRT, 86 (22.2%) died, and 52 (13.4%) suffered a major non-fatal CV event. On multivariate analysis, longitudinal change in cFGF23 was significantly associated with risk for death and progression to RRT but not non-fatal cardiovascular events.
In our study, increasing cFGF23 was significantly associated with risk for death and RRT.
成纤维细胞生长因子 23（FGF23）在 CKD 中升高，并与死亡、心血管（CV）事件和进展至肾脏替代治疗（RRT）等结局相关。大多数研究都无法解释 FGF23 随时间的变化，而那些已经证明了相互矛盾的结果。我们进行了一项生存分析，观察 c 末端 FGF23（cFGF23）随时间的变化，以评估 cFGF23 对这些结局的相对贡献。
我们测量了 388 名 CKD 3-5 期患者的血浆样本中的 cFGF23，这些患者有 cFGF23 的系列测量值，平均每个患者有 4.2 个样本。我们使用线性回归分析评估 cFGF23 的年变化率，并在 cox 回归分析中评估时间变化的 cFGF23 与结局之间的关系。
在我们的人群中，中位基线 eGFR 为 32.3mls/min/1.73m，中位基线 cFGF23 为 162 相对单位/ml（RU/ml）（IQR 101-244 RU/mL）。在超过 70 个月（IQR 53-97）的中位随访期间，76（19.6%）名患者进展为 RRT，86（22.2%）名患者死亡，52（13.4%）名患者发生重大非致命性 CV 事件。多变量分析显示，cFGF23 的纵向变化与死亡和进展为 RRT 的风险显著相关，但与非致命性心血管事件无关。
在我们的研究中，cFGF23 的增加与死亡和 RRT 的风险显著相关。
