title: Fibroblast growth factor 23 is associated with left ventricular hypertrophy, not with uremic vasculopathy in peritoneal dialysis patients.
abstract: OBJECTIVE
  Cardiovascular (CV) events are the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), including those patients on peritoneal dialysis (PD). Fibroblast growth factor 23 (FGF23) has been associated with left ventricular hypertrophy (LVH) and mortality in patients with CKD. However, the role of FGF23 in uremic vasculopathy remains unclear. In this study, we aimed to assess the relationship between FGF23 and LVH, endothelial dysfunction, vascular calcification, and arterial stiffness in 48 stable PD patients.
  
  
  METHODS
  Left ventricular mass index (LVMI) was assessed using 2-D echocardiography. Intact FGF23 blood levels were evaluated using an ELISA kit (Immutopics, Inc., San Clemente, CA, USA). Reactive hyperemia index (RHI) is a surrogate marker of endothelial dysfunction and the augmentation index (AI) is a surrogate marker of arterial stiffness. Both were assessed using peripheral arterial tonometry (EndoPAT 2000). Vascular calcification (VC) was assessed using the Adragão score.
  
  
  RESULTS
  In unadjusted analysis; FGF23 was positively correlated with serum Pi (r = 0.487, p < 0.001), serum urea (r = 0.351, p = 0.015), serum creatinine (r = 0.535, p < 0.001), dialysis vintage (r = 0.309, p = 0.033), and LVMI (r = 0.369, p = 0.027) and was negatively correlated with age (r = -0.343, p = 0.017), residual renal function (r = -0.359, p < 0.012), and AI (r = -0.304, p = 0.038). In multivariate adjusted analysis, FGF23 was associated with LVMI (β = 0.298, p = 0.041), serum Pi (β = 0.345, p = 0.018), and age (β = -0.372, p = 0.007) independent of dialysis vintage, gender, residual renal function (RRF), albumin, C-reactive protein and systolic blood pressure. There were no associations found between FGF23 and RHI, AI, or VC in multivariable- adjusted models.
  
  
  CONCLUSIONS
  Our results show that FGF23 is associated with LVH but not with endothelial dysfunction, arterial stiffness, or vascular calcification in PD patients.
authors.forename: Margarida
authors.initials: M
authors.lastname: Sarmento-Dias
authors.forename: Carla
authors.initials: C
authors.lastname: Santos-Araújo
authors.forename: Rui
authors.initials: R
authors.lastname: Poínhos
authors.forename: Bruno
authors.initials: B
authors.lastname: Oliveira
authors.forename: Isabell Soares
authors.initials: IS
authors.lastname: Silva
authors.forename: Liliana Simões
authors.initials: LS
authors.lastname: Silva
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Sousa
authors.forename: Flora
authors.initials: F
authors.lastname: Correia
authors.forename: Manuel
authors.initials: M
authors.lastname: Pestana
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D002097:C-Reactive Protein / Q000032:analysis; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000379:methods; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D006940:Hyperemia / Q000097:blood; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000209:etiology; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010710:Phosphates / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications*; D012709:Serum Albumin / Q000032:analysis; D014508:Urea / Q000097:blood; D014511:Uremia / Q000150:complications; D061205:Vascular Calcification / Q000209:etiology; D059289:Vascular Stiffness / Q000502:physiology
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D010710:Phosphates; D012709:Serum Albumin; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D014508:Urea; D002097:C-Reactive Protein; D003404:Creatinine