FGF23 and Left Ventricular Hypertrophy in Children with CKD
FGF23 and Left Ventricular Hypertrophy in Children with CKD
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DOI：
10.2215/cjn.02110217
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发表时间：
2018-01-06
影响因子：
9.8
通讯作者：
Portale, Anthony A.
中科院分区：
文献类型：
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作者：
Mitsnefes, Mark M.;Betoko, Aisha;Portale, Anthony A.
背景与目的成纤维细胞生长因子23 （FGF23）高血浆浓度是CKD患者左室肥厚（LVH）的危险因素，可诱导实验性CKD患者心肌肥厚。我们假设高FGF23水平与CKD患儿LVH患病率升高有关。我们对587名参加儿童慢性肾病（CKiD）研究的轻度至中度CKD儿童进行了超声心动图检查，并测量了血浆c -末端FGF23浓度。我们使用线性和逻辑回归分析血浆FGF23与左心室质量指数（LVMI）和LVH （LVMI >= 95百分位）的关系，并根据人口统计学、体重指数、eGFR和ckd特异性因素进行调整。我们还通过eGFR水平检测了FGF23与LVH之间的关系。结果中位年龄为12岁（四分位数范围8-15），eGFR为50 ml/min / 1.73 m(2)（四分位数范围38-64）。LVH的总患病率为11%。调整人口统计学和体重指数后，FGF23浓度>= 170 RU/ml的受试者LVH发生率比FGF23浓度>= 45 ml/min / 1.73 m2的受试者高2.53(95%可信区间，1.28至4.97;P < 0.01)， FGF23浓度>= 100 RU/ml、100-169 RU/ml和>= 170 RU/ml的受试者LVH患病率分别为5.4%、11.2%和15.3% （P趋势=0.01）。当eGFR为>= 45 ml/min / 1.73 m(2)时，较高的FGF23浓度与LVH独立相关（完全调整比值比，FGF23最高与最低类别为3.08；95%可信区间为1.02 ~ 9.24;P < 0.05；完全调整比值比，FGF23翻倍为2.02；95%可信区间为1.29 ~ 3.17;P < 0.01）。相比之下，在eGFR为45ml/min / 1.73 m(2)的参与者中，FGF23与LVH无关。结论血浆FGF23浓度>= 170 RU/ml是eGFR >= 45 ml/min / 1.73 m儿童LVH的独立预测因子(2)。
Background and Objectives High plasma concentration of fibroblast growth factor 23 (FGF23) is a risk factor for left ventricular hypertrophy (LVH) in adults with CKD, and induces myocardial hypertrophy in experiment CKD. We hypothesized that high FGF23 levels associate with a higher prevalence of LVH in children with CKD.Design, setting, participants, & measurements We performed echocardiograms and measured plasma C-terminal FGF23 concentrations in 587 children with mild-to-moderate CKD enrolled in the Chronic Kidney Disease in Children (CKiD) study. We used linear and logistic regression to analyze the association of plasma FGF23 with left ventricular mass index (LVMI) and LVH (LVMI >= 95th percentile), adjusted for demographics, body mass index, eGFR, and CKD-specific factors. We also examined the relationship between FGF23 and LVH by eGFR level.Results Median age was 12 years (interquartile range, 8-15) and eGFR was 50 ml/min per 1.73 m(2) (interquartile range, 38-64). Overall prevalence of LVH was 11%. After adjustment for demographics and body mass index, the odds of having LVH was higher by 2.53 (95% confidence interval, 1.28 to 4.97; P < 0.01) in participantswith FGF23 concentrations >= 170 RU/ml compared with those with FGF23= 45 ml/min per 1.73 m2, the prevalence of LVH was 5.4%, 11.2%, and 15.3% for those with FGF23,100 RU/ml, 100-169 RU/ml, and >= 170 RU/ml, respectively (P-trend=0.01). When eGFR was >= 45 ml/min per 1.73 m(2), higher FGF23 concentrations were independently associated with LVH(fully adjusted odds ratio, 3.08 in the highest versus lowest FGF23 category; 95% confidence interval, 1.02 to 9.24; P < 0.05; fully adjustedodds ratio, 2.02 perdoubling of FGF23; 95% confidence interval, 1.29 to 3.17; P < 0.01). By contrast, in participantswith eGFR, 45ml/min per 1.73 m(2), FGF23 did not associatewith LVH.Conclusions Plasma FGF23 concentration >= 170 RU/ml is an independent predictor of LVH in children with eGFR >= 45 ml/min per 1.73 m(2).