Impact of fibroblast growth factor-23 on blood pressure and pulse pressure in hemodialysis patients; a multicenter study

Abstract

Introduction: Hypertension seems to be a major problem in dialysis patients. Fibroblast growth factor-23 (FGF-23) appears to be a risk factor for mortality in patients with end-stage renal disease (ESRD). Objectives: This study aims to investigate FGF-23 and its association with blood pressure and pulse pressure among hemodialysis patients. Patients and Methods: This cross-sectional multicenter study was performed on 135 patients aged 18 years and over with ESRD treated with hemodialysis. Systolic and diastolic blood pressure of all patients was measured. FGF-23, uric acid, Na and K were measured using blood test and fasting. We used univariate and multivariate linear and non-linear regression. Results: The mean age of patients was 56.45±13.64 years. Around 60% of patients were male. The mean and median FGF-23 in patients was 855.07±43.33 pg/mL and 762.6 pg/mL (IQR=456.6-1430.3) respectively. After adjustment for age, gender, dialysis time, uric acid, Na, K and kt/V, FGF-23 had quadratic association with pulse pressure. We found, each 10-unit (pg/mL) increase in FGF-23 was significantly associated with 0.50 mm Hg decrease in minimum pulse pressure (P=0.002) and 0.42 mm Hg decrease in mean pulse pressure (P= 0.009). Conclusions: FGF23 had a significant association with dialysis vintage and a significant reverse association with minimum and mean pulse pressure.