title: The Association between Fibroblast Growth Factor-23 and Vascular Calcification Is Mitigated by Inflammation Markers.
abstract: BACKGROUND
  Fibroblast growth factor-23 (FGF-23) has been linked to vascular calcification, ventricular hypertrophy and mortality in chronic kidney disease (CKD), although these links may not be direct and independent. Similar grave outcomes are associated with inflammation and oxidative stress in CKD. Recently, accumulating evidence has linked components of phosphate homeostasis to inflammation and oxidative stress. The interaction between the triad of inflammation, FGF-23 and cardiovascular outcomes is underinvestigated.
  
  
  METHODS
  We studied 65 patients with stage 5 CKD on hemodialysis. Serum levels of FGF-23, high-sensitivity C-reactive protein (hsCRP), endogenous soluble receptor of advanced glycation end products (esRAGE), advanced oxidation protein products (AOPP), parathormone, lipids, calcium and phosphorous were measured. The aortic calcification index (ACI) was determined using non-contrast CT scans of the abdominal aorta.
  
  
  RESULTS
  FGF-23 was elevated (mean: 4,681 pg/ml, SD: 3,906) and correlated with hsCRP, esRAGE, AOPP, dialysis vintage and phosphorus in univariate analysis. In multiple regression analysis, hsCRP, AOPP and phosphorus but not esRAGE were all significantly correlated to FGF-23 (R2= 0.7, p < 0.001). In univariate analysis, ACI correlated with hsCRP, esRAGE, FGF-23, dialysis vintage, systolic blood pressure (BP) and serum cholesterol. In multiple regression analysis not including inflammation markers, ACI was associated with FGF-23. However, inclusion of inflammation markers in another multiple regression analyses showed that ACI correlated with hsCRP, BP, dialysis vintage and esRAGE but not with FGF-23 (R2= 0.65, p < 0.001).
  
  
  CONCLUSIONS
  FGF-23 is strongly correlated to various markers of inflammation and oxidative stress in hemodialysis patients. The association between FGF-23 and vascular calcification was mitigated when corrected for inflammation markers.
authors.affiliation: Department of Nephrology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Nasrallah
authors.affiliation: Department of Medical Biochemistry, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Amal R
authors.initials: AR
authors.lastname: El-Shehaby
authors.affiliation: Department of Nephrology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Noha A
authors.initials: NA
authors.lastname: Osman
authors.affiliation: Department of Nephrology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: Fayad
authors.affiliation: Department of Radiology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Nassef
authors.affiliation: Department of Endocrinology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mona M
authors.initials: MM
authors.lastname: Salem
authors.affiliation: Department of Nephrology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Usama A A
authors.initials: UA
authors.lastname: Sharaf El Din
keywords: Chronic kidney disease; Chronic kidney disease ; Fibroblast growth factor-23; Inflammation markers; Uremic toxins; Vascular calcification