title: Serum fibroblast growth factor-21 concentration is associated with residual renal function and insulin resistance in end-stage renal disease patients receiving long-term peritoneal dialysis.
abstract: Fibroblast growth factor-21 (FGF-21) is a new metabolic regulator, which is related to antiobesity and insulin sensitivity in vivo. However, the clinical implication of FGF-21 is poorly understood. To investigate whether FGF-21 may play a role as a metabolic regulator in patients with end-stage renal disease, we measured serum concentrations of FGF-21, inflammatory markers, and metabolic parameters in healthy people (n = 63) and nondiabetic patients receiving peritoneal dialysis (PD, n = 72). The patients were treated with angiotensin receptor blocker for 6 months, and the changes in FGF-21 concentration and metabolic parameters were assessed. Compared with controls, serum FGF-21 concentration was 8 times higher in patients undergoing PD (754.2 ± 463.5 vs 86.9 ± 60.2 pg/mL, P < .001). In controls, only lipid parameters correlated positively with FGF-21 concentration. In contrast, inflammatory markers (interleukin-6, fibrinogen, high-sensitivity C-reactive protein) and homeostasis model assessment of insulin resistance (HOMA-IR) correlated positively and residual renal function correlated inversely with serum FGF-21 concentration in PD patients. In a multivariate analysis adjusting these factors, residual renal function, HOMA-IR, and fibrinogen concentration were independent determinants of serum FGF-21 concentration. After 6-month angiotensin receptor blocker treatment, serum FGF-21 concentration declined significantly by 13% and HOMA-IR and inflammatory markers improved in PD patients. These findings suggest that FGF-21 may play a role in insulin resistance in patients with end-stage renal disease.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Choi
authors.forename: Bong Jun
authors.initials: BJ
authors.lastname: Cho
authors.forename: Yenna
authors.initials: Y
authors.lastname: Lee
authors.forename: Soo
authors.initials: S
authors.lastname: Lim
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Park
authors.forename: Min Kyung
authors.initials: MK
authors.lastname: Moon
authors.forename: Hong Kyu
authors.initials: HK
authors.lastname: Lee
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Dae Suk
authors.initials: DS
authors.lastname: Han
authors.forename: Young-Bum
authors.initials: YB
authors.lastname: Kim
authors.forename: Hak C
authors.initials: HC
authors.lastname: Jang
authors.forename: Kyong Soo
authors.initials: KS
authors.lastname: Park
mesh_terms: D000328:Adult; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D015415:Biomarkers; D016022:Case-Control Studies; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005346:Fibroblast Growth Factors / Q000097:blood* / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007249:Inflammation; D007333:Insulin Resistance; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis
chemical_list: D057911:Angiotensin Receptor Antagonists; D015415:Biomarkers; C414620:fibroblast growth factor 21; D005346:Fibroblast Growth Factors; D005340:Fibrinogen