接受腹膜透析患者的血清成纤维细胞生长因子23浓度与死亡风险

Serum fibroblast growth factor 23 concentration and the risk of mortality in patients undergoing peritoneal dialysis.

作者信息

Zhong Zhong, Feng Shaozhen, Fu Dongying, Li Bin, Li Zhijian, Mao Haiping

机构信息

Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

NHC Key Laboratory of Clinical Nephrology (Sun Yat-sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.

出版信息

Perit Dial Int. 2024 May;44(3):194-202. doi: 10.1177/08968608241231697. Epub 2024 Mar 6.

DOI:10.1177/08968608241231697

PMID:38449341

Abstract

BACKGROUND

Fibroblast growth factor 23 (FGF23) is a phosphate-regulating hormone that is secreted in large amounts early in chronic kidney disease. In this cohort, we aimed to investigate the association between serum FGF23 concentration and mortality in patients undergoing peritoneal dialysis (PD).

METHODS

Serum FGF23 level was determined by enzyme-linked immunosorbent assay (ELISA) in a large 15-year prospective cohort study of PD patients with stored serum samples at baseline. Kaplan-Meier survival curves and Cox proportional hazards models were performed to characterise the relationship of FGF23 with mortality.

RESULTS

A total of 737 incident PD patients were analysed. The baseline median FGF23 concentration was 683.2 (518.5-896.2) pg/mL. Age, serum phosphorus, high-density lipoprotein cholesterol and high-sensitivity C-reactive protein were independently correlated with serum FGF23 concentration. During a median follow-up of 66.7 (41.1-95.4) months, 171 of the 737 participants (23.2%) died, including 84 (49.1%) cardiovascular disease-related and 50 (29.2%) infection-related deaths. Multivariable Cox regression analysis showed that the adjusted hazard ratios of the highest tertile of serum FGF23 compared with those in the lowest tertile were 1.36 (95% confidence interval (CI): 0.89-2.07; = 0.154), 0.75 (95% CI: 0.40-1.38; = 0.353) and 2.66 (95% CI: 1.15-6.15; = 0.022) for all-cause, cardiovascular disease-related and infection-related mortality, respectively.

CONCLUSION

High serum FGF23 concentration is associated with a higher risk of infection-related death for incident PD patients.

摘要

背景

成纤维细胞生长因子23（FGF23）是一种调节磷酸盐的激素，在慢性肾脏病早期大量分泌。在本队列研究中，我们旨在探讨接受腹膜透析（PD）患者的血清FGF23浓度与死亡率之间的关联。

方法

在一项为期15年的大型前瞻性队列研究中，通过酶联免疫吸附测定（ELISA）法测定基线时储存血清样本的PD患者的血清FGF23水平。采用Kaplan-Meier生存曲线和Cox比例风险模型来描述FGF23与死亡率之间的关系。

结果

共分析了737例新发PD患者。基线时FGF23浓度中位数为683.2（518.5 - 896.2）pg/mL。年龄、血清磷、高密度脂蛋白胆固醇和高敏C反应蛋白与血清FGF23浓度独立相关。在中位随访66.7（41.1 - 95.4）个月期间，737名参与者中有171例（23.2%）死亡，其中84例（49.1%）死于心血管疾病相关原因，50例（29.2%）死于感染相关原因。多变量Cox回归分析显示，血清FGF23最高三分位数与最低三分位数相比，全因死亡率、心血管疾病相关死亡率和感染相关死亡率的调整后风险比分别为1.36（95%置信区间（CI）：0.89 - 2.07；P = 0.154）、0.75（95%CI：0.40 - 1.38；P = 0.353）和2.66（95%CI：1.15 - 6.15；P = 0.022）。