title: Baseline FGF23 is Associated with Cardiovascular Outcome in Incident PD Patients.
abstract: ♦
  
  
  BACKGROUND
  Fibroblast growth factor 23 (FGF23) is a phosphate regulating protein. Several studies demonstrated that elevated FGF23 is independently associated with mortality for early-stage chronic kidney disease and incident hemodialysis (HD) patients. However, little is known about the significance of elevated FGF23 in peritoneal dialysis (PD) patients. Here, we analyzed the association of FGF23 with cardiovascular (CV) events, all-cause mortality, residual renal function (RRF), and CV parameters in PD patients. ♦
  
  
  METHODS
  The present study is a single-center, retrospective study. Patients who started PD at Seoul National University Hospital between January 2005 and July 2011 and whose baseline serum samples were available were enrolled. C-terminal FGF23 was measured. Subjects were divided into 2 groups; lower 2 tertiles (FGF23 ≤ 119.0 RU/mL) and top tertile (FGF23 > 119.0 RU/mL). The primary outcome was time to fatal or non-fatal CV events. In the subgroup analysis, the associations of FGF23 with aortic stiffness or with vascular calcification were analyzed. ♦
  
  
  RESULTS
  A total of 205 incident PD patients were analyzed. Mean duration of follow-up was 41.6 ± 20.0 months. The baseline median FGF23 level was 78.6 RU/mL (inter-quartile range [IQR], 34.1 - 155.0). At baseline, subjects in the higher FGF23 group were younger, and had a lower RRF, lower prevalence of diabetes mellitus (DM), and cerebrovascular disease. During follow-up, 22 of the 205 patients (10.7%) reached primary outcome. After adjustment for age, DM, pre-existing coronary artery disease, cerebrovascular disease, congestive heart failure, and left ventricular mass index, the higher FGF23 group exhibited significantly higher risk of primary outcome, compared with the lower group (hazard ratio [HR], 2.54; 95% confidence interval [CI], 1.05 - 6.12; p = 0.045). There were no significant differences in all-cause mortality and development of anuria between the 2 FGF23 groups. In the subgroup analysis, FGF23 groups were not associated with pulse wave velocity and abdominal aortic calcification score. ♦
  
  
  CONCLUSIONS
  Elevated FGF23 is associated with higher risk of adverse CV outcome for incident PD patients.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyo Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Miseon
authors.initials: M
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Transplantation Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hayne Cho
authors.initials: HC
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Transplantation Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jong Cheol
authors.initials: JC
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Kwon Wook
authors.initials: KW
authors.lastname: Joo
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Young-Hwan
authors.initials: YH
authors.lastname: Hwang
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jaeseok
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Transplantation Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Curie
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Clinical Research Institute, Seoul National University Hospital, Seoul, Korea khoh@snu.ac.kr.
authors.forename: Kook-Hwan
authors.initials: KH
authors.lastname: Oh
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology* / Q000503:physiopathology; D002423:Cause of Death; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012189:Retrospective Studies
chemical_list: C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: FGF23; Peritoneal dialysis; cardiovascular disease; fibroblast growth factor 23