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Relationship between serum fibroblast growth factor-23 level and mortality in chronic hemodialysis patients

  • Nephrology - Original Paper
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Abstract

Background

Fibroblast growth factor-23 (FGF23) is a phosphate-regulating hormone and is found to be markedly increased in patients with chronic kidney disease. The aim of the present study was to evaluate the relationship between serum FGF23 levels and mortality, including the impact of gender and cardiovascular disease (CVD), in a Japanese cohort of chronic hemodialysis (HD) patients.

Methods

Ninety-two maintenance dialysis patients (58 men; mean age 60.3 years) were included. Serum intact FGF23, calcium, phosphate, albumin, intact parathyroid hormone (PTH), and C-reactive protein were measured at baseline. CVD was defined as clinical symptoms and/or a history of CVD.

Results

During a median follow-up time of 53.2 months, 24 patients (26 %) died. Serum FGF23 levels were positively correlated with serum levels of calcium (r = 0.5433, P < 0.0001), phosphate (r = 0.5048, P < 0.0001), calcium × phosphate product (r = 0.6801, P < 0.0001), and intact PTH (r = 0.2710, P = 0.0090) (r = 0.27, P < 0.0001). In Cox proportional hazard models, serum FGF23 level was not associated with increased mortality risk, neither in crude nor in multivariate-adjusted models. However, in a subgroup analysis of women with previous CVD, serum FGF23 level above median was associated with higher cardiovascular event risk in crude models (hazard ratio 9.52, 95 % confidence interval 1.56–86.11, P = 0.0129). Kaplan–Meier analysis stratifying for the presence of CVD demonstrated a significant higher mortality risk in patients with history of CVD and higher serum FGF23 levels (P < 0.0001).

Conclusion

Serum FGF23 level was not associated with increased mortality risk in this cohort of prevalent HD patients. These results suggest that the impact of FGF23 on mortality may be modified by gender and previous CVD and is blunted in the grade of hyperphosphatemia.

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Acknowledgments

We thank the staff of dialysis center in Hidaka hospital for collecting medical records. This work was supported by the grants from the Japan research promotion society for cardiovascular diseases.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Himiko Sugimoto, Yuko Iwabuchi & Kosaku Nitta

  2. Department of Medicine, Medical Center East, Tokyo Women’s Medical University, Arakawa-ku, Tokyo, 116-8567, Japan

    Tetsuya Ogawa & Kuniaki Otsuka

Authors
  1. Himiko Sugimoto
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  2. Tetsuya Ogawa
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  3. Yuko Iwabuchi
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  4. Kuniaki Otsuka
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  5. Kosaku Nitta
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Corresponding author

Correspondence to Kosaku Nitta.

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Sugimoto, H., Ogawa, T., Iwabuchi, Y. et al. Relationship between serum fibroblast growth factor-23 level and mortality in chronic hemodialysis patients. Int Urol Nephrol 46, 99–106 (2014). https://doi.org/10.1007/s11255-013-0386-2

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  • DOI: https://doi.org/10.1007/s11255-013-0386-2

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