Fibroblast Growth Factor 23 is a Predictor of Aortic Artery Calcification in Maintenance Hemodialysis Patients

Figures & data

Figure 1. Aortic artery calcification score.

Table 1. Clinical characteristics of MHD patients.

Parameters	Results	Reference range
Number (n)	120	–
Sex male (%)	71 (59.2)	–
Age (years)	55.1 ± 14.9 (20–85)	–
BMI (kg/m^2)	21.71 ± 3.81	–
Vintage (month)	39.1 (1.0–225.5)	–
SBP (mmHg)	139.3 ± 13.3	–
DBP (mmHg)	81.6 ± 9.2	–
Pre-albumin (mg/L)	302.8 ± 73.9	180–380
ALT (IU/L)	14.3 ± 8.5	16–64
AST (IU/L)	14.6 ± 6.0
ALP (IU/L)	90.9 (33.0–1001.0)	38.0–126.0
TP (g/L)	63.1 ± 6.0
Albumin (g/L)	34.5 ± 4.1	35.0–55.0
BUN (mmol/L)	24.7 ± 6.3	2.5–7.1
SCR (umol/L)	1035.9 ± 264.1	Male: 62–115; Female: 53–97
UA (umol/L)	449.5 ± 77.0	160–430
iPTH (pg/ml)	1046.9 (8.5–86401.0)	130–600
25 (OH) D (nmol/L)	50.9 ± 26.2	50.0–80.0
TG (mmol/L)	2.27 (0.41–14.58)	0.56–1.70
TC (mmol/L)	4.04 ± 1.08	2.33–5.7
HDL (mmol/L)	1.09 ± 0.34
LDL (mmol/L)	2.22 ± 0.77
cFGF23 (RU/ml)	27691.42 (69.94–351947.34)	–
LgFGF23	3.82 ± 0.79	–
P (mg/ml)	5.69 ± 1.86	2.5–4.5
tCa (mg/ml)	9.43 ± 0.95	8.5–10.0

Notes: *Reference range according to KDIGO CKD-MBD guideline. BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; TP, total protein; BUN, blood urea nitrogen; SCR, serum creatinine; UA, uric acid; iPTH, intact parathyroid hormone; TG, triglyceride; TC,cholesterol; HDL, high density lipoprotein; LDL, low density lipoprotein; P, phosphate; tCa, total calcium.

Figure 2. (A) Correlations between Lg FGF23 and Lg Vintage (r = 0.413, p < 0.001). (B) Lg PTH (r = 0.283, p = 0.002). (C) serum phosphate (r = 0.587, p < 0.001). (D) total calcium (r = 0.419, p < 0.001). (E) 25(OH)D (r = 0.195, p = 0.033). (F) SCR (r = 0.415, p < 0.001).

Figure 3. Bivariate correlation between Lg FGF23 level and AAC score (r = 0.371, P < 0.001).

Table 2. Stepwise multiple regression for factors associated with FGF23 P, Phosphate; Total Ca, total calcium; PTH, parathyroid hormone; SCR, serum creatinine.

		95% Condidence interval for β
	β	Lower bound	Upper bound	R^2	P -Value
P	0.206	0.151	0.216	0.345	<0.001
Total Ca	0.392	0.290	0.494	0.209	<0.001
Lg PTH	0.318	0.143	0.494	0.043	<0.001
SCR	0.001	0.000	0.001	0.020	0.001
Pre-albumin	–0.002	–0.003	0.000	0.020	0.015

Table 3. Baseline characteristics and AAC Score of MHD patients by quartiles of FGF23 level.

FGF-23 level	Q1 (<1311RU/mL)	Q2 (1311-5602RU/mL)	Q3 (5602-2578RU/mL)	Q4 (>25784RU/mL)	P Value
N	30	30	30	30	–
Age (year)	56.67 ± 15.9	55.4 ± 14.7	55.4 ± 14.0	53.1 ± 15.5	0.836
Sex male (%)	17 (56.7)	20 (66.7)	19 (63.3)	15 (50.0)	0.565
Vintage (month)	21.7 ± 21.4	28.6 ± 26.9	47.7 ± 46.1	58.3 ± 40.4**	<0.001
Lg Vintage	1.13 ± 0.48	1.26 ± 0.45	1.49 ± 0.44	1.63 ± 0.39**	<0.001
Pre-Alb (mg/L)	295.4 ± 63.7	305.0 ± 66.8	309.5 ± 86.3	301.5 ± 79.7	0.903
ALT (IU/L)	147 ± 8.5	17.1 ± 12.0	12.3 ± 5.0	12.9 ± 6.4	0.116
AST (IU/L)	16.4 ± 6.7	15.0 ± 6.2	13.4 ± 5.2	13.7 ± 5.7	0.209
ALP (IU/L)	83.5 ± 49.8	67.4 ± 18.7	112.6 ± 189.8	99.9 ± 80.3	0.386
TP (g/L)	63.6 ± 6.4	63.9 ± 5.6	62.2 ± 4.53	62.6 ± 7.2	0.655
ALB (g/L)	35.6 ± 3.6	34.4 ± 3.3	33.1 ± 3.3	34.9 ± 5.4	0.108
BUN(mmol/L)	21.9 ± 5.5	24.3 ± 5.2	26.2 ± 6.5	26.3 ± 7.2	0.021
SCR (umol/L)	839.1 ± 262.7	1046.5 ± 212.2**	1097.0 ± 189.4**	1161.2 ± 275.6**	<0.0001
UA (umol/L)	449.5 ± 79.8	439.7 ± 70.5	450.1 ± 85.5	458.5 ± 74.3	0.831
iPTH (pg/mL)	222.9 ± 191.1	220.2 ± 166.9	306.1 ± 408.2	587.2 ± 500.0	0.298
Lg iPTH	2.12 ± 0.54	2.18 ± 0.44	2.17 ± 0.58	2.66 ± 0.62**	<0.001
25(OH)D(nmol/ml)	40.9 ± 26.2	51.1 ± 22.0	55.3 ± 24.4	56.2 ± 30.0	0.089
TG (mmol/L)	2.36 ± 2.57	2.52 ± 2.54	2.22 ± 1.81	1.99 ± 1.89	0.825
Lg TG	0.27 ± 0.27	0.28 ± 0.31	0.24 ± 0.30	0.19 ± 0.29	0.678
TC (mmol/L)	4.00 ± 1.25	3.78 ± 0.74	4.04 ± 1.16	4.33 ± 1.09	0.266
HDL (mmol/L)	1.05 ± 0.25	1.02 ± 0.35	1.06 ± 0.37	1.21 ± 0.38	0.158
LDL (mmol/L)	2.14 ± 0.95	2.04 ± 0.66	2.20 ± 0.68	2.47 ± 0.71	0.157
P (mg/mL)	4.33 ± 1.12	5.11 ± 1.40	6.20 ± 1.79**	7.12 ± 1.76**	<0.001
tCa (mg/mL)	9.00 ± 0.79	9.08 ± 0.73	9.80 ± 1.04	9.84 ± 0.93**	<0.001
SBP (mmHg)	138.6 ± 10.7	141.7 ± 13.1	139.0 ± 13.4	13708 ± 15.8	0.691
DBP (mmHg)	80.1 ± 8.9	83.8 ± 10.6	80.9 ± 7.1	81.5 ± 10.1	0.440
BMI (kg/m^2)	21.7 ± 3.5	22.5 ± 3.8	20.8 ± 3.8	21.9 ± 4.0	0.406
AAC seg.	0.84 ± 0.15	1.52 ± 0.28	1.43 ± 0.26**	1.69 ± 0.31**	0.001
AAC Score	1.59 ± 0.29	4.82 ± 0.88	4.53 ± 0.83**	6.92 ± 1.26**	<0.001

Notes: Results are expressed as mean ± SD or number of observations (precentage). ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; TP, total protein; ALB, albumin; BUN, urea nitrogen; SCR, serum creatinine; UA, uric acid; iPTH, intact parathyroid hormone; 25(OH)D, 25-hydroxyvitamin D; TG, triglyceride; TC, cholesterol; HDL, high density lipoprotein; LDL, low density lipoprotein; P, phosphate; tCa, total calcium; AAC seg., aortic artery calcification segments affected. *p < 0.05, **p < 0.001, compared to the first quartile.

Table 4. Forward logistic regression for factors associated AAC Score.

	Odds ratios	95% Confidence interval	p-value
Age (years)	1.088	1.050–1.128	<0.001
Lg FGF23	2.366	1.304–4.291	0.005
Total protein (g/L)	0.921	0.844–1.004	0.06