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

Figures & data

Table 1. Baseline characteristics of patients undergoing maintenance hemodialysis according to median serum FGF21 level (150.15 pg/mL).

Factors	All patients (n = 147)	Low-FGF21 (≤150.15 pg/mL, n = 74)	High-FGF21 (>150.15 pg/mL, n = 73)	P value
General data
Age (years)	58.49 ± 14.41	55.04 ± 15.50	59.86 ± 13.44	0.046*
Male gender, n (%)	86 (58.50)	46 (62.16)	40 (54.79)	0.365
Body mass index (kg/m^2)	22.43 (20.24–26.77)	23.80 (20.88–25.61)	21.94 (19.59–27.83)	0.920
Systolic BP (mmHg)	143.55 ± 23.46	143.11 ± 23.31	141.97 ± 24.75	0.775
Diastolic BP (mmHg)	77.22 ± 13.41	80.22 ± 13.26	76.73 ± 13.66	0.118
Dialysis vintage(years)	3.30 (1.20–8.00)	3.20 (1.45–7.60)	3.95 (1.18–9.40)	0.904
Comorbidity
Diabetes mellitus, n (%)	47 (31.97)	23 (31.08)	24 (32.88)	0.815
Hypertension, n (%)	138 (93.88)	71 (95.95)	67 (91.78)	0.327
History of CVD, n (%)	40 (27.21)	22 (29.73)	18 (24.66)	0.490
Medications
Calcium supplements, n (%)	34 (23.13)	18 (24.32)	16 (21.92)	0.729
Cinacalcet, n (%)	26 (17.69)	16 (21.62)	10 (13.70)	0.208
ACEIs/ARBs, n (%)	52 (35.37)	30 (40.54)	22 (30.14)	0.187
Laboratory data
Hemoglobin (g/L)	100.32 ± 19.45	103.19 ± 18.39	98.43 ± 19.97	0.134
Albumin (g/L)	38.30(35.00–40.20)	38.70 (35.20–40.40)	37.70 (34.10–40.23)	0.157
Uric acid (mmol/L)	366.37 ± 137.42	363.80 ± 144.39	373.52 ± 130.63	0.669
Total cholesterol (mmol/L)	4.06 ± 1.08	4.05 ± 1.04	4.07 ± 1.18	0.901
Triglycerides (mmol/L)	1.44 (1.00–2.14)	1.40 (1.01–2.13)	1.55 (0.99–2.16)	0.481
HDL-C (mmol/L)	1.08 ± 0.31	1.10 ± 0.30	1.06 ± 0.29	0.500
LDL-C (mmol/L)	2.33 ± 0.84	2.32 ± 0.87	2.38 ± 0.83	0.671
Calcium (mmol/L)	2.27 (2.12–2.45)	2.28 (2.13–2.45)	2.26 (2.11–2.46)	0.686
Phosphate (mmol/L)	1.68 ± 0.58	1.82 ± 0.58	1.68 ± 0.65	0.179
Parathyroid hormone (pg/mL)	232.90(95.00–418.00)	232.90 (105.10–413.80)	221.90 (88.10–413.80)	0.258
C-reactive protein (mg/L)	7.06 (0.98–21.60)	7.05 (0.86–17.75)	7.18 (1.65–26.00)	0.312
BNP (pg/mL)	355.00 (98.00–1020.00)	341.00 (96.88–948.00)	395.00 (97.00–1141.00)	0.495
Kt/V	1.26 (1.23–1.30)	1.26 (1.23–1.30)	1.26 (1.23–1.30)	0.730
FGF21 (pg/mL)	150.15 (70.57–318.01)	70.93 (36.36–118.96)	318.01 (216.78–527.15)	<0.001*

BMI: body mass index; BP: blood pressure; HDL-C: high-density lipoprotein-cholesterol; LDL-C: low-density lipoprotein-cholesterol; BNP: brain natriuretic peptide; FGF21: fibroblast growth factor 21; CVD: cardiovascular disease. *Differences between the low FGF21 group and the high FGF21 group (p < 0.05).

Figure 1. Kaplan–Meier estimate of AVF functional patency in patients undergoing maintenance hemodialysis with low levels of serum FGF21 (≤150.15 pg/mL) and high levels of serum FGF21 (>150.15 pg/mL) (p < 0.001; log-rank test).

Table 2. Cox proportional hazard models on the risk of arteriovenous fistula failure in patients undergoing maintenance hemodialysis.

Covariate	Univariate analysis		Multivariable analysis
	Hazard Ratio (95% CI)	P value	Hazard Ratio (95% CI)	P value
Age (years)	1.022 (0.996–1.048)	0.105
Male gender	0.501 (0.243–1.031)	0.061	0.416 (0.196-0.884)	0.022
Diastolic BP (mmHg)	0.972 (0.946–1.000)	0.046
Calcium (mmol/L)	0.524 (0.255–1.075)	0.078	0.378 (0.182-0.788)	0.009
Parathyroid hormone (pg/mL)	0.999 (0.997–1.000)	0.061
Cinacalcet	0.290 (0.069–1.218)	0.091
ACEIs/ARBs	0.411 (0.168–1.005)	0.051
FGF21 (pg/mL)	1.002 (1.001–1.003)	0.004	1.002 (1.001-1.003)	0.003

BP: blood pressure; FGF21: fibroblast growth factor 21.

Figure 2. Kaplan–Meier estimate of overall survival in patients undergoing maintenance hemodialysis with low levels of serum FGF21 (≤150.15 pg/mL) and high levels of serum FGF21 (>150.15 pg/mL) (p = 0.016; log-rank test).

Table 3. Cox proportional hazard models on the risk of overall survival in patients undergoing maintenance hemodialysis.

Covariate	Univariate analysis		Multivariable analysis
	Hazard Ratio (95% CI)	P value	Hazard Ratio (95% CI)	P value
Age (years)	1.057 (1.024–1.092)	0.001
Diastolic BP (mmHg)	0.958 (0.931–0.986)	0.004	0.946 (0.909–0.985)	0.006
Albumin (g/L)	0.947 (0.907–0.990)	0.016
Total cholesterol (mmol/L)	0.512 (0.322–0.814)	0.005	0.346 (0.172–0.695)	0.003
LDL-C (mmol/L)	0.444 (0.239–0.827)	0.010
Phosphate (mmol/L)	0.498 (0.247–1.004)	0.051
Parathyroid hormone (pg/mL)	0.998 (0.997–1.000)	0.054
BNP (pg/mL)	1.000 (1.000–1.001)	<0.001	1.000 (1.000-1.001)	0.017
Diabetes mellitus	2.050 (0.917–4.582)	0.080
History of CVD	2.858 (1.281–6.377)	0.010
Cinacalcet	0.202 (0.027–1.498)	0.118
FGF21 (pg/mL)	1.001 (1.000–1.003)	0.013	1.002 (1.000-1.003)	0.014

BP: blood pressure; LDL-C: low-density lipoprotein-cholesterol; BNP: brain natriuretic peptide; FGF21: fibroblast growth factor 21.

Figure 3. ROC curve of the predictive value of FGF21 for AVF functional patency loss. AUC, area under the curve.

Figure 4. Kaplan–Meier estimate of AVF functional patency in patients undergoing maintenance hemodialysis with low levels of serum FGF21 (≤149.98 pg/mL) and high levels of serum FGF21 (>149.98 pg/mL) (p < 0.001; log-rank test).

Figure 5. ROC curve of the predictive value of FGF21 for all-cause mortality. AUC, area under the curve.

Figure 6. Kaplan–Meier estimate of overall survival in patients undergoing maintenance hemodialysis with low levels of serum FGF21 (≤146.43 pg/mL) and high levels of serum FGF21 (>146.43 pg/mL) (p = 0.003; log-rank test).

Data availability statement

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