The Relationship Between Serum FGF23 Level And Calcium-phosphorus Metabolism And Clinical Relevance In Patients With Chronic Kidney Disease

Objective To investigate the changes of serum fibroblast growth factor 23(FGF23)in patients with chronic kidney disease(CKD),its value in the early diagnosis of chronic kidney disease-abnormal mineral bone metabolism(CKD-MBD)and its clinical relevance.Methods 140 patients with CKD were selected from the nephrology department of the Second Affiliated Hospital of Anhui Medical University from April 2017 to March2018,and 18 healthy persons who had physical examination in our hospital were included in the control group.The laboratory indexes such as calcium(Ca),phosphorus(P),hemoglobin(Hb),albumin(ALB),bone alkaline phosphatase(BALP),parathyroid hormone(PTH)and FGF23 were measured,echocardiography was undergone,and blood pressure was monitored in the morning quiet state.According to the glomerular filtration rate and dialysis or not,CKD patients were divided into 3 stage group 26 cases,4 stage group 29 cases,5 stage non dialysis group(5ND)55 cases,5phase hemodialysis group(5HD)30 cases,compare the indexes between each group,and analyze the influence factors of serum FGF23 level.According to the presence or absence of left ventricular hypertrophy(LVH),they were divided into group LVH and group NLVH.According to the presence or absence of cardiac valve calcification,they were divided into cardiac valve calcification group and non-cardiac valve calcification group.Two groups of indicators were compared,and Logistic regression analysis was used to construct regression models for risk factors of LVH and cardiac valve calcification.Results 1.the logFGF23 of 3 stage group(1.83±0.19),4 stage group(1.91±0.16),5ND group(1.99±0.18)and 5HD group(2.12±0.12)were significantly higher than those of the control group(1.74±0.14)(P<0.05),and went up as the CKD progressed.2.Ca(2.13±0.19),P(1.20±0.21),logPTH(1.74±0.21)in the 3 stage group were all within the normal range.3.Hb and Ca in the 5ND group were significantly lower than those in other groups(P<0.05).P was significantly higher than those in other groups(P<0.05).4.BALP and logPTH in the 5ND group and the 5HD group were significantly higher than those in the 3 stage group and the 4 stage group(P<0.05).5.FGF23 was positively correlated with P,SCr,BALP,PTH and SBP(P<0.05),and negatively correlated with Hb(P<0.05).6.R*C tableχ~2 test showed that CKD stage was moderately correlated with left ventricular hypertrophy,Cramer’s V=0.376,P=0.001,and weakly correlated with cardiac valve calcification,Cramer’s V=0.264,P=0.044.7.Age,FGF23 and SBP were independent risk factors for LVH.Age and FGF23 were independent risk factors for cardiac valve calcification.Conclusion Serum FGF23 level is increasing with the progress of CKD,and its change is earlier than Ca,P and PTH.FGF23 is an independent risk factor for LVH and cardiac valve calcification.It can be used as a predictor of CKD-MBD in patients with CKD and is closely related to clinical practice.