Abstract
Fibroblast growth factor 21 (FGF21) is an endocrine factor that regulates glucose and lipid metabolism. Circulating FGF21 predicts cardiovascular events and mortality in type 2 diabetes mellitus, including early-stage chronic kidney disease, but its impact on clinical outcomes in end-stage renal disease (ESRD) patients remains unclear. This study enrolled 90 ESRD patients receiving chronic hemodialysis who were categorized into low- and high-FGF21 groups by the median value. We investigated the association between circulating FGF21 levels and the cardiovascular event and mortality during a median follow-up period of 64 months. A Kaplan-Meier analysis showed that the mortality rate was significantly higher in the high-FGF21 group than in the low-FGF21 group (28.3% vs. 9.1%, log-rank, P = 0.034), while the rate of cardiovascular events did not significantly differ between the two groups (30.4% vs. 22.7%, log-rank, P = 0.312). In multivariable Cox models adjusted a high FGF21 level was an independent predictor of all-cause mortality (hazard ratio: 3.98; 95% confidence interval: 1.39–14.27, P = 0.009). Higher circulating FGF21 levels were associated with a high mortality rate, but not cardiovascular events in patient with ESRD, suggesting that circulating FGF21 levels serve as a predictive marker for mortality in these subjects.
Highlights
Fibroblast growth factor 21 (FGF21), a member of the FGF family, is a hormone that regulates the glucose and lipid metabolism as well as the responses to several stresses [1,2,3,4,5]
We investigated the association of circulating FGF21 levels with the rates of cardiovascular events and mortality in end-stage renal disease (ESRD) patients receiving hemodialysis (HD)
No significant differences were observed in gender, Body mass index (BMI), duration of dialysis, serum albumin, intact parathyroid hormone (PTH), insulin-like growth factor-1 (IGF-1), total cholesterol, LDL-cholesterol, triglyceride levels or medications, including lipid-lowering therapy and cardiovascular medications (Table 1)
Summary
Fibroblast growth factor 21 (FGF21), a member of the FGF family, is a hormone that regulates the glucose and lipid metabolism as well as the responses to several stresses [1,2,3,4,5]. Circulating FGF21 levels are elevated in various metabolic disease states, such as obesity, insulin resistance, and type 2 diabetes mellitus [8, 9]. The circulating FGF21 level increases progressively from the early to end stages of chronic kidney disease (CKD) and is associated with the renal function [10, 11]. The FGF21 level is an independent biomarker of rapid CKD progression in patients at early stages of diabetic nephropathy [14, 15]. Recent studies showed that the circulating FGF21 level predicts the rates of cardiovascular events and mortality in patients with type 2 diabetes [16, 17] and coronary artery disease [18]. The impact of the circulating FGF21 level on the clinical outcome in patients with advanced CKD remains unclear
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