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Fibroblast growth factor-23 and cardiovascular disease among prevalent hemodialysis patients focusing on residual kidney function

Authors
 Youn Kyung Kee  ;  Hee Jung Jeon  ;  Jieun Oh  ;  Ajin Cho  ;  Young-Ki Lee  ;  Jong-Woo Yoon  ;  Hyunsuk Kim  ;  Tae-Hyun Yoo  ;  Dong Ho Shin 
Citation
 FRONTIERS IN ENDOCRINOLOGY, Vol.14 : 1099975, 2023-07 
Journal Title
FRONTIERS IN ENDOCRINOLOGY
Issue Date
2023-07
MeSH
Cardiovascular Diseases* / epidemiology ; Cardiovascular Diseases* / etiology ; Cross-Sectional Studies ; Fibroblast Growth Factor-23 ; Humans ; Kidney ; Kidney Failure, Chronic* ; Renal Dialysis / adverse effects ; Ventricular Dysfunction, Left* / epidemiology ; Ventricular Dysfunction, Left* / etiology
Keywords
cardiovascular disease ; fibroblast growth factor-23 ; hemodialysis patients ; left ventricular diastolic dysfunction ; residual kidney function
Abstract
BackgroundIn patients undergoing incident hemodialysis, increased fibroblast growth factor-23 (FGF-23) levels are associated with the development of cardiovascular disease (CVD), but the influence of residual kidney function (RFK) on this association is unclear. This study aimed to investigate the association between FGF-23 levels, RKF, and CVD in patients undergoing prevalent hemodialysis. MethodsThis cross-sectional and longitudinal observational study included 296 patients undergoing maintenance hemodialysis for at least three months who were followed up for a median of 44 months. RKF was defined as 24-h urine output >200 mL, left ventricular (LV) diastolic dysfunction as E/E' >15 on echocardiographic parameters. CVD was defined as hospitalization or emergency room visits due to cardiovascular causes, such as angina, myocardial infarction, or congestive heart failure. ResultsThe median intact FGF-23 (iFGF-23) level was 423.8 pg/mL (interquartile range, 171-1,443). Patients with an FGF-23 level > 423.8 pg/mL significantly had a lower proportion of RKF (39.2% vs. 60.1%, P < 0.001) and a higher proportion of LV diastolic dysfunction (54. 1% vs. 29.1%, P < 0.001) than those with an iFGF-23 level & LE; 423.8 pg/mL. The odds ratio (OR) for LV diastolic dysfunction was significantly higher in patients with RFK (OR per one-unit increase in the natural log-transformed iFGF-23 levels, 1.80; 95% confidence interval [CI]: 1.11-2.93) than in patients without RKF (OR per one-unit increase in the natural log-transformed iFGF-23 levels: 1.42; 95% CI: 1.01-1.99) in multivariate analysis (p < 0.001). During the follow-up period, 55 patients experienced CVD. The hazard ratio (HR) for CVD development was also significantly higher in patients with RKF (HR per one-unit increase in the natural log-transformed iFGF-23 levels, 2.64; 95% CI: 1.29-5.40) than those without RKF (HR per one-unit increase in the natural log-transformed iFGF-23 levels: 1.44; 95% CI: 1.04-1.99) in multivariate analysis (p = 0.05). ConclusionsIncreased iFGF-23 levels were associated with LV diastolic dysfunction and CVD development in patients undergoing prevalent hemodialysis; however, the loss of RKF attenuated the magnitude of these associations. Therefore, in these patients, RKF strongly influenced the detrimental role of iFGF-23 in the development of CVD.
Files in This Item:
T999202510.pdf Download
DOI
10.3389/fendo.2023.1099975
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kee, Youn Kyung(기연경)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198310
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