Original Article
Impact of serum fibroblast growth factor(FGF)23 and carotid intima-media thickness on long-term outcome in maintenance hemodialysis patients
Aiqun Chen, Ying Sun, Ban Zhao, Ju Cui, Haitao Wang, Ping Zeng, Yonghui Mao
Published 2019-07-14
Cite as Chin J Geriatr, 2019, 38(7): 769-774. DOI: 10.3760/cma.j.issn.0254-9026.2019.07.013
Abstract
ObjectiveTo 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.
MethodsA 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.
ResultsThe 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.
ConclusionsSerum 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
Contributor Information
Aiqun Chen
Department of Nephrology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Ying Sun
Department of Nephrology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Ban Zhao
Department of Nephrology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Ju Cui
Beijing Hospital, Laboratory of Medical Molecular Biology, National Center of Gerontology, Beijing 100730, China
Haitao Wang
Department of Nephrology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Ping Zeng
Beijing Hospital, Laboratory of Epidemiology, National Center of Gerontology, Beijing 100730, China
Yonghui Mao
Department of Nephrology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
