Abstract
IntroductionFew studies have linked high levels of plasma C-terminal fibroblast growth factor 23 (FGF23) with poor clinical outcomes in patients on maintenance haemodialysis (MHD), while the association between intact FGF23 and mortality in this group of patients remains inconclusive.Therefore, the aim of this study was to evaluate the association between plasma levels of intact FGF23 and mortality in dialysis patients.MethodsA prospective multicenter study involving patients undergoing dialysis at three dialysis centers in Johannesburg was undertaken between 1st October 2014 and 31st December 2017.ResultsThe study comprised 165 chronic dialysis patients (111 blacks, 54 whites) with a mean age of 46.6 ±14.2 years. During a three year follow up period, there were 46 deaths (1.03 per 100 person-years). The median plasma FGF 23 level was 382 pg/ml (interquartile range [IQR], 145–2977). In adjusted multivariable analyses, there was a non-statistically significant increase in the risk of mortality with higher quartiles of FGF 23 levels: the adjusted hazard ratios (HR) for the second, third and fourth quantiles were HR 3.20 (95% CI, 0.99–10.35; P = 0.052), HR 2.43(95% CI,0.65–9.09; P = 0.19), and HR 2.09 (95% CI, 0.66–7.32; P = 0.25),respectively. Corrected serum calcium 2.38–2.5 mmol/l [HR 2.98 (95% CI, 1.07–8.29; P = 0.04] and > 2.50 mmol/l [HR 5.50 (95% CI, 1.84–16.48; P = 0.002] were independently associated with increased risk of death. Likewise, patients with intact parathyroid hormone > 600 pg/ml had a 3.46-fold higher risk of death (HR 3.46, 95% CI, 1.22–9.82 P = 0.019). These findings persisted in time -dependent analyses.ConclusionHigher levels of intact FGF 23 appear not to be independently associated with all-cause mortality in our dialysis patients, while hypercalcaemia and severe hyperparathyroidism were found to be independent predictors of mortality in this cohort of patients.
Highlights
Few studies have linked high levels of plasma C-terminal fibroblast growth factor 23 (FGF23) with poor clinical outcomes in patients on maintenance haemodialysis (MHD), while the association between intact FGF23 and mortality in this group of patients remains inconclusive.the aim of this study was to evaluate the association between plasma levels of intact FGF23 and mortality in dialysis patients
The discovery of FGF23 has led to further insights into the pathogenesis of chronic kidney disease–mineral and bone disorder (CKD-MBD), accounting for the paradigm shift from the classic trade off hypothesis to an updated trade off hypothesis[5]
The incidence of mortality remains unacceptably high in CKD patients, despite interventions on traditional risk factors and the need to identify other non-traditional risk factors for death in CKD patients, such as FGF23
Summary
The aim of this study was to evaluate the association between plasma levels of intact FGF23 and mortality in dialysis patients. This study aimed to determine the relationship between FGF23, traditional markers of CKD-MBD and mortality in patients on dialysis; and tested the hypothesis that high level of plasma FGF23 is expected to be an independent predictor of all -cause mortality in South African patients on maintenance haemodialysis
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