High levels of serum fibroblast growth factor (FGF)-23 are associated with increased mortality in long haemodialysis patients
High levels of serum fibroblast growth factor (FGF)-23 are associated with increased mortality in long haemodialysis patients
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DOI：
10.1093/ndt/gfp191
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发表时间：
2009-09-01
影响因子：
6.1
通讯作者：
Chazot, Charles
中科院分区：
文献类型：
--
作者：
Jean, Guillaume;Terrat, Jean-Claude;Chazot, Charles
方法。从2006年9月起在一个血液透析中心接受治疗的所有患者都被纳入研究。记录标准实验室值、病史、心血管事件和危险因素、用药和FGF-23水平[ELISA （C-Term）免疫球蛋白]。患者每周接受3次血液透析，每次5- 8小时。根据FGF-23四分位数分析患者数据。使用Cox比例风险模型评估FGF-23对2年生存率的影响，并根据混杂变量和血清磷酸盐含量进行调整。该研究包括219名患者。血清FGF-23水平高：7060 +/- 13500 RU/mL（中位数为2740 RU/mL）。在逻辑回归中，只有钙血症（P = 0.002）、磷血症（P = 0.008）和华法林使用（P = 0.04）与最高的FGF-23四分位数相关。在估计VC评分的患者亚组中，FGF-23水平的第三和第四个四分位数与更严重的VC相关。在多变量线性回归中，只有磷血症与FGF-23保持显著相关（P = 0.04）。血清FGF-23水平在高四分位数的血液透析患者的2年死亡率显著更高[P = 0.007；风险比（2.5(1.3-5)）]高于第一个四分位数，而在磷血症三分位数中，血清FGF-23最低的四分位数与死亡率降低相关。该研究表明，尽管罕见的高磷血症，但LHD患者的循环FGF-23水平较高。然而，磷血症仍然是与血清FGF-23相关的主要因素。因此，无论血清磷酸盐水平如何，血清FGF-23水平升高与死亡率和VC之间的关联已得到证实。
Methods. All patients treated in one haemodialysis centre from September 2006 were included in the study. Standard laboratory values, medical history, cardiovascular events and risk factors, medication and FGF-23 levels [ELISA (C-Term) Immutopics] were recorded. Patients received haemodialysis three times a week, on a 5- to 8-h schedule. Patient data were analysed according to FGF-23 quartiles. The effect of FGF-23 on the 2-year survival rate was assessed using the Cox proportional hazard model, adjusted for confounding variables and according to the serum phosphate tertiles.Results. The study included 219 patients. Serum FGF-23 levels were high: 7060 +/- 13 500 RU/mL (median, 2740 RU/mL). In logistical regressions, only calcaemia (P = 0.002), phosphataemia (P = 0.008) and warfarin use (P = 0.04) were associated with the highest FGF-23 quartile. In the subgroup of patients with an estimated VC score, the third and fourth quartiles of the FGF-23 levels were associated with more severe VC. In multivariate linear regressions, only phosphataemia remained significantly correlated with FGF-23 (P = 0.04). The 2-year mortality rate was significantly higher for haemodialysis patients with serum FGF-23 levels in the higher quartile [P = 0.007; hazard ratio, 2.5 (1.3-5)] than in the first quartile, whereas within the phosphataemia tertiles, the lowest serum FGF-23 quartile was associated with lowered mortality.Conclusion. This study demonstrated a high level of circulating FGF-23 in LHD patients, despite infrequent hyperphosphataemia. However, phosphataemia is still the main factor correlating with serum FGF-23. The association of higher serum FGF-23 levels with mortality and VC, regardless of the serum phosphate levels, has thus been confirmed.