title: FGF-23 levels are associated with vascular calcification, but not with atherosclerosis, in hemodialysis patients.
abstract: OBJECTIVE
  High fibroblast growth factor-23 (FGF-23) levels are associated with mortality and cardiovascular events in patients with chronic kidney disease. The aim of this cross-sectional study was to investigate the relationship between plasma FGF-23 levels and coronary artery calcification and carotid artery intima-media thickness (CA-IMT) in hemodialysis (HD) patients.
  
  
  METHODS
  In this cross-sectional study, plasma intact FGF-23 levels were measured in 229 patients who underwent coronary artery calcification scores (CACs) determined by multi-slice computerized tomography and CA-IMT assessed by using high-resolution color Doppler ultrasonography.
  
  
  RESULTS
  Median FGF-23 was 53.5 pg/ml (IQR 30.8-249.5). Median CACs was 98 (IQR 0-531), and the frequency of patients with severe calcification (CACs > 400) was 28.8%; 27.5% of cases had no calcification. Mean CA-IMT was 0.78 ± 0.20 mm, and the presence of carotid plaques was 51% with a mean length 2.1 mm. FGF-23 level was positively correlated with serum calcium (r = 0.337, p < 0.001), phosphate (r = 0.397, p < 0.001) and CACs (r = 0.218, p = 0.001). Neither CA-IMT nor the presence of carotid artery plaques correlated with FGF-23 levels. In adjusted ordinal regression analysis, FGF-23 level was an independent predictor for severe CACs together with age, gender, presence of diabetes, time on dialysis and CA-IMT (model r(2) = 0.44, p < 0.001). As a novel finding, the mean CACs was markedly higher in patients with FGF-23 level above median regardless of phosphate levels (p = 0.03).
  
  
  CONCLUSIONS
  In HD patients, plasma FGF-23 level is superior to phosphate in the prediction of coronary artery calcification. However, FGF-23 is not associated with carotid artery atherosclerosis in HD patients.
authors: Division of Nephrology, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey. mnturan@mail.com.
authors: Mehmet Nuri
authors: MN
authors: Turan
authors: Division of Nephrology, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
authors: Fatih
authors: F
authors: Kircelli
authors: Division of Nephrology, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
authors: Mustafa
authors: M
authors: Yaprak
authors: Department of Biochemistry, Dokuz Eylul University School of Medicine, Izmir, Turkey.
authors: Ali Riza
authors: AR
authors: Sisman
authors: Division of Nephrology, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
authors: Ozkan
authors: O
authors: Gungor
authors: Department of Radiology, Ege University School of Medicine, Izmir, Turkey.
authors: Selen
authors: S
authors: Bayraktaroglu
authors: Division of Nephrology, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
authors: Mehmet
authors: M
authors: Ozkahya
authors: Division of Nephrology, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
authors: Gulay
authors: G
authors: Asci
authors: Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Aachen, Germany.
authors: Jurgen
authors: J
authors: Floege
authors: Division of Nephrology, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
authors: Ercan
authors: E
authors: Ok
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D050197:Atherosclerosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D061205:Vascular Calcification / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D055815:Young Adult
chemical_list: C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: Carotid artery intima-media thickness; Coronary artery calcification; Fibroblast growth factor-23; Hemodialysis