Impact of serum fibroblast growth factor(FGF)23 and carotid intima-media thickness on long-term outcome in maintenance hemodialysis patients

Abstract

Objective To assess the predictive value of serum fibroblast growth factor(FGF)23 level and carotid intima-media thickness(CIMT)for the long-term outcome in maintenance hemodialysis(MHD)patients. Methods A total of 88 MHD patients were enrolled, with a median follow-up of 73.2 months(a range from 11.5 to 75.7 months). CIMT and atherosclerotic plaques were measured by B-mode Doppler ultrasound at baseline by an experienced sonographer.Blood samples were collected and stored in the -80℃ refrigerator for measuring serum FGF23 levels. Results The 88 patients were aged(64.2±11.5)years, with 52 males and 36 females, and the mean CIMT was(1.34±0.38)mm.Carotid artery atherosclerotic plaque was detected in 72(81.8%)subjects.Carotid artery atherosclerotic plaques(CASP)were found in 58(65.9%)patients aged 60 years and over.Compared with non-elderly patients, elderly patients had the characteristics of high incidence of cardiovascular disease and poor nutritional status.During the follow-up period, 34 patients died and 23(67.6%)patients died of cardiovascular disease.Kaplan-Meier curves showed that cardiovascular disease-free survival rate was higher in the normal CIMT group than in thickening CIMT group(Log Rank P=0.003). And subjects with low level of FGF23 had a better survival rate than those with moderate to high level of FGF23(Log Rank P=0.043). Multivariate COX regression analysis showed that FGF23(HR=1.056, 95%CI: 1.007-1.108, P=0.026)and CIMT(HR=1.165, 95%CI: 1.032-1.315, P=0.013)were independent predictors for cardiovascular mortality.Multivariate COX regression analysis showed that serum calcium(HR=0.022, 95%CI: 0.001-0.489, P=0.016), hemoglobin(HR=0.966, 95%CI: 0.937-0.997, P=0.033), FGF23(HR=1.071, 95%CI: 1.017-1.128, P=0.010)and CIMT(HR=1.202, 95%CI: 1.049-1.377, P=0.008)were independent predictors for cardiovascular mortality in elderly MHD patients. Conclusions Serum level of FGF23 and CIMT are the important predictors for cardiovascular mortality in MHD patients.The proportion of elderly patients with cardiovascular disease is higher, in which the factors affecting prognosis are more complex. Key words: Maintenance hemodialysis; Tunia media; Fibroblast growth fator 23; Prognosis