The association of fibroblast growth factor 23 with atherosclerosis and arterial stiffness in peritoneal dialysis patients
The association of fibroblast growth factor 23 with atherosclerosis and arterial stiffness in peritoneal dialysis patients
Aim: Increased serum fibroblast growth factor-23 (FGF-23) levels are associated with adverse cardiovascular events in chronickidney disease patients. The aim of our study was to investigate the association of FGF-23 with atherosclerosis and arterial stiffnessin patients with peritoneal dialysis (PD).Material and Methods: This cross-sectional study was performed in 55 (34 (61.8%) male/21 (38.2%) female) PD patients with amean age of 53.1±11.4 years. The presence of atherosclerosis was determined by carotid artery-intima media thickness (CA-IMT)and the presence of arterial stiffness was determined by brachial-ankle pulse wave velocity (baPWV). Residual renal function wasdetermined by residual glomerular filtration rate (rGFR), renal creatinine clearance (CCr), and residual urine output. FGF-23 andsoluble klotho (s-KL) levels were determined by enzyme-linked immunosorbent assay.Results: CA-IMT (p < 0.001), baPWV (p = 0.003 ), log10 FGF-23 (p < 0.001) were higher and s-KL (p < 0.001) was lower compared withthe healthy controls. rGFR (p= 0.007), residual diuresis (p = 0.004) and renal CCr (p = 0.001) were higher in patients with log10 FGF-23≤ 2.16 than log10 FGF-23 > 2.16. In multiple regression analysis there was an inverse relationship between log10 FGF-23 and rGFR (p =0.032), residual diuresis (p = 0.048), renal CCr (p = 0.045). There was no relationship with log10 FGF-23 and CA-IMT, baPWV (p > 0.05).Conclusion: Increased atherosclerosis and arterial stiffness were detected in PD patients compared to healthy subjects. There wasno relationship between FGF-23 and atherosclerosis and arterial stiffness in PD patients.
___
- 1. Prichard S. Major and minor risk factors for cardiovascular
disease in peritoneal dialysis. Perit Dial Int 2000;20 S154-9.
- 2. Attman PO, Samuelsson OG, Moberly J, et al.
ApolipoproteinB-containing lipoproteins in renal failure: the
relation to mode of dialysis. Kidney Int 1999;55:1536-42.
- 3. Gao N, Kwan BC, Chow KM, et al. Arterial pulse wave velocity
and peritoneal transport characteristics independently
predict hospitalization in Chinese peritoneal dialysis
patients. Perit Dial Int 2010;30:80-5.
- 4. Covic A, Goldsmith DJ, Florea L, et al. The influence of dialytic
modality on arterial stiffness, pulse wave reflections, and
vasomotor function. Perit Dial Int 2004;24:365-72.
- 5. Szeto CC, Kwan BC, Chow KM, et al. Prognostic value of
arterial pulse wave velocity in peritoneal dialysis patients.
Am J Nephrol 2012;35:127-33.
- 6. Jung JY, Hwang YH, Lee SW, et al. Factors associated
with aortic stiffness and its change over time in peritoneal
dialysis patients. Nephrol Dial Transplant 2010;25:4041-8.
- 7. Fukagawa M, Kazama JJ. With or without the kidney: the
role of FGF23 in CKD. Nephrology Dialysis Transplantation
2005;20:1295–1298.
- 8. Adragao T, Pires A, Lucas C, et al. A simple vascular
calcification score predicts cardiovascular risk in
hemodialysis patients. Nephrol Dial Transplant
2004;19:1480-8.
- 9. Balci M, Kirkpantur A, Gulbay M, et al. Plasma fibroblast
growth factor-23 levels are independently associated with
carotid arteryatherosclerosis in maintenance hemodialysis
patients. Hemodial Int 2010;14:425-32.
- 10. Shimada T, Kakitani M, Yamazaki Y, et al. Targeted ablation
of FGF23 demonstrates an essential physiological role
of FGF23 in phosphate and vitamin D metabolism. J Clin
Invest 2004;113:561-8.
- 11. Inaba M, Okuno S, Imanishi Y, et al. Role of fibroblast
growth factor-23 in peripheral vascular calcification in nondiabetic
and diabetic hemodialysis patients. Osteoporos Int
2006;17:1506-13.
- 12. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the
concentration of low-density lipoprotein cholesterol in
plasma, without use of the preparative ultracentrifuge. Clin
Chem 1972;18:499-502.
- 13. Canada-USA (CANUSA) peritoneal dialysis study group.
Adequacy of dialysis and nutrition in continuous peritoneal
dialysis: association with clinical outcomes. J Am Soc
Nephrol 1996;7:198-207.
- 14. Van-Olden RW, Krediet RT, Struijk DG, et al. Measurement of
residual renal function in patients treated with continuous
peritoneal dialysis. J Am Soc Nephrol 1996;7:745-50.
- 15. Twardowski ZJ, Nolph KO, Khanna R, et al. Peritoneal
equilibration test. Perit Dial Bull 1987;7:138-47.
- 16. Szeto CC, Chow KM, Woo KS, et al. Carotid intima media
thickness predicts cardiovascular diseases in Chinese predialysis
chronic kidney diseases patients. J Am Soc Nephrol
2007;18:1966-72.
- 17. Yokoyama H, Shoji T, Kimoto E, et al. Pulse wave velocity in
lower-limb arteries among diabetic patients with peripheral
arterial disease. J Atheroscler Thromb 2003;10:253-8.
- 18. Rossi A, Bonfante L, Giacomini A, et al. Carotid artery
lesions in patients with nondiabetic chronic renal failure.
Am J Kidney Dis 1996;27:58-66.
- 19. Avram MM, Fein PA, Antignani A, et al. Cholesterol and
lipid disturbances in renal disease: the natural history of
uremic dyslipidemia and the impact of hemodialysis and
continuous ambulatory peritoneal dialysis. Am J Med
1989;87:55N-60N.
- 20. Johansson AC, Samuelsson O, Attman PO, et al. Dyslipidemia
in peritoneal dialysis-relation to dialytic variables. Perit Dial
Int 2000;20:306-14.
- 21. Kronenberg F, Konig P, Neyer U, et al. Multicenter study of
lipoprotein (a) and apolipoprotein(a) phenotypes in patients
with end-stage renal disease treated by hemodialysis
or continuous ambulatory peritoneal dialysis. J Am Soc
Nephrol 1995;6:110-20.
- 22. Wang AY. Cardiovascular risk factors in peritoneal dialysis
patients revisited. Perit Dial Int 2007;27:S223-7.
- 23. Chung AW, Yang HH, Kim JM, Sigrist MK, Brin G, Chum
E, Gourlay WA, Levin A. Arterial stiffness and functional
properties in chronic kidney disease patients on different
dialysis modalities: an exploratory study. Nephrol Dial
Transplant 2010;25:4031-41.
- 24. Sipahioglu MH, Kucuk H, Unal A, et al. Impact of arterial
stiffness on adverse cardiovascular outcomes and mortality
in peritoneal dialysis patients. Perit Dial Int 2012;32:73–80.
- 25. Yamashina A, Tomiyama H, Arai T, et al. Brachial-ankle pulse
wave velocity as a marker of atherosclerotic vascular damage
and cardiovascular risk. Hypertens Res 2003;26:615-22.
- 26. Asicioglu E, Kahveci A, Arikan H, et al. Fibroblast
Growth Factor-23 Levels Are Associated with Vascular
Calcifications in Peritoneal Dialysis Patients. Nephron Clin
Pract 2013;124:89-93.
- 27. Zeng Y, Feng S, Han OY, et al. Role of fibroblast growth
factor-23 in the pathogenesis of atherosclerosis in peritoneal
dialysis patients. Genet Mol Res 2015;14:719-29.
- 28. Moldovan D, Moldovan I, Rusu C, et al. FGF-23, vascular
calcification, and cardiovascular diseases in chronic
hemodialysis patients. Int Urol Nephrol 2014;46:121-8.
- 29. Janda K, Krzanowski M, Chowaniec E, et al. Osteoprotegerin
as a marker of cardiovascular risk in patients on peritoneal
dialysis. Pol Arch Med Wewn 2013;123:149-55.
- 30. Page DE, Knoll GA, Cheung V. The relationship between
residual renal function, protein catabolic rate, and phosphate
and magnesium levels in peritoneal dialysis patients. Adv
Perit Dial 2002;18:189-91.
- 31. Kuhlmann MK. Phosphate elimination in modalities
of hemodialysis and peritoneal dialysis. Blood Purif
2010;29:137-44.
- 32. Jimbo R, Kawakami-Mori F, Mu S, et al. Fibroblast growth
factor 23 accelerates phosphate-induced vascular
calcification in the absence of Klotho deficiency. Kidney Int
2014;85:1103-11.
- 33. Yamada S, Tsuruya K, Taniguchi M, et al. Relationship
Between Residual Renal Function and Serum Fibroblast
Growth Factor 23 in Patients on Peritoneal Dialysis. Ther
Apher Dial 2014;18:383-90.
- 34. Ozdemir FN, Güz G, Sezer S, et al. Atherosclerosis risk is
higher in continuous ambulatory peritoneal dialysis patients
than in hemodialysis patients. Artif Organs 2001;25:448-52.
- 35. Ashikaga E, Honda H, Suzuki H, et al. Impact of fibroblast
growth factor 23 on lipids and atherosclerosis in
hemodialysis patients. Ther Apher Dial 2010;14:315-22.