Fibroblast growth factor 21 predicts arteriovenous fistula functional patency loss and mortality in patients undergoing maintenance hemodialysis

Abstract

Background

Arteriovenous fistula (AVF) dysfunction is a common complication in patients undergoing maintenance hemodialysis (MHD). Elevated serum levels of fibroblast growth factor 21 (FGF21) are associated with atherosclerosis and cardiovascular mortality. However, its association with vascular access outcomes remains elusive. The present study evaluated the relationship of serum FGF21 levels with AVF dysfunction and all-cause mortality in patients undergoing MHD.

Methods

We included patients undergoing MHD using AVF from January 2018 to December 2019. FGF21 concentration was detected using enzyme-linked immunosorbent assay. Patients were followed up to record two clinical outcomes, AVF functional patency loss and all-cause mortality. The follow-up period ended on April 30, 2022.

Results

Among 147 patients, the mean age was 58.49 ± 14.41 years, and the median serum level of FGF21 was 150.15 (70.57–318.01) pg/mL. During the median follow-up period of 40.83 months, the serum level of FGF21 was an independent risk factor for AVF functional patency loss (per 1 pg/mL increase, HR 1.002 [95% CI: 1.001–1.003, p = 0.003]). Patients with higher serum levels of FGF21 were more likely to suffer from all-cause mortality (per 1 pg/mL increase, HR 1.002 [95% CI: 1.000–1.003, p = 0.014]). The optimal cutoffs for FGF21 to predict AVF functional patency loss and all-cause mortality in patients undergoing MHD were 149.98 pg/mL and 146.43 pg/mL, with AUCs of 0.701 (95% CI: 0.606–0.796, p < 0.001) and 0.677 (95% CI: 0.595–0.752, p = 0.002), respectively.

Conclusions

Serum FGF21 levels were an independent risk factor and predictor for AVF functional patency loss and all-cause mortality in patients undergoing MHD.

Keywords:

• Fibroblast growth factor 21
• hemodialysis
• arteriovenous fistula
• functional patency
• all-cause mortality

Author contributions

X-HH, HL and BW were responsible for the design and concept. X-HH developed the first draft of the manuscript. HD made modifications and improvements to the manuscript. QW, R-XC, W-TZ, L-QJ, JW, H-FL and J-YC were responsible for the statistical analysis. HL and BW were responsible for the guidance and review of the thesis. All authors revised the final manuscript and made suggestions.

Ethical approval

This study was performed in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Zhongda Hospital Affiliated to Southeast University (Ethical approval ID: 2019ZDKYSB191). The informed consent was waived because of the retrospective design of the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Additional information

Funding

This work was supported by grants from the National Natural Science Foundation of China (82070735, 82241047), the Foundation of Jiangsu Commission of Health (M2021048), the Project of Taizhou Clinical Medical School of Nanjing Medical University (TZKY20220209), and the Open Project of Jiangsu Key Laboratory of Geriatric Disease Prevention and Treatment with Integrated Traditional Chinese and Western Medicine(202243).