Research On Relationship Between Fibroblast Growth Factor-23,Soluble Klotho And Cardiac Valve Calcification In Continuous Ambulatory Peritoneal Dialysis Patients

Objective:Cardiovascular events are one of the main causes of death in patients with end-stage renal disease,and cardiac valve calcification is one of the most important risk factors for cardiovascular events.Recent studies have shown that fibroblast growth factor-23 and soluble Klotho protein are associated with mineral metabolic disorders and vascular calcification in chronic kidney disease.However,there are few studies on the relationship between fibroblast growth factor-23,soluble Klotho protein and cardiac valve calcification in peritoneal dialysis patients.The purpose of this study was to understand the clinic features of cardiac valve calcification in patients from peritoneal dialysis center of the first affiliated hospital of Soochow University through a cross-sectional study,and analyze the relationship between fibroblast growth factor-23,soluble Klotho protein and cardiac valve calcification,then evaluate the diagnostic value of soluble fibroblast growth factor-23 and soluble klotho in patients with cardiac valve calcification,Finally provide a theoretical basis for clinical diagnosis and treatment of cardiac valve calcification in peritoneal dialysis patients.Methods:One hundred and forty-seven of continuous ambulatory peritoneal dialysis patients from dialysis center of the first affiliated hospital of Soochow University were enrolled,whose clinical datum were recorded.The level of fibroblast growth factor-23 and soluble klotho were measured by enzyme-linked immunosorbent assay.Echocardiography was applied to evaluate cardiac valve calcification.The patients were divided into normal cardiac valve group(group A)and cardiac valve calcification group(group B).SPSS 23.0 software was used for data analysis.Spearman analysis and multivariate logistic regression analysis was used to analysis the risk factors of cardiac valve calcification.The diagnostic value of soluble fibroblast growth factor-23 and soluble klotho in patients with cardiac valve calcification was evaluated by the receiver-operating characteristic curve.Result:1.The incidence of cardiac valve calcification in continuous ambulatory peritoneal dialysis patients was 54.42%(80/147).2.The risk of cardiac valve calcification showed positive correlation with age,dialysis age,serum creatinine,corrected calcium,serum phosphorus,serum alkaline phosphatase,parathyroid hormone,the level of serum fibroblast growth factor-23(P<0.05),and negative correlated with urea clearance index,the level of soluble klotho and residual renal function(P<0.05).3.The level of serum fibroblast growth factor-23 showed positive correlation with age,dialysis age,serum creatinine,corrected calcium,serum alkaline phosphatase,serum phosphorus,parathyroid hormone(P＜0.05),and negative correlated with the level of soluble klotho,residual renal function and urea clearance index(P<0.05).4.The level of serum soluble klotho showed positive correlated with urea clearance index and residual renal function(P＜0.05),and negative correlated with age,dialysis age,serum creatinine,serum phosphorus,parathyroid hormone,and corrected calcium(P＜0.05).5.Patients were divided into four subgroups according to quartiles of distribution rang of soluble fibroblast growth factor-23 or soluble klotho.Positive correlation was observed between the risk of cardiac valve calcification and the level of fibroblast growth factor-23.The analysis results presented significant negative correlation between the risk of cardiac valve calcification and the level of soluble klotho in peritoneal dialysis patients.6.Multivariate logistic regression analysis showed that the increase of soluble fibroblast growth factor-23(OR=5.007,95%CI 1.446-17.339,P=0.011)and serum phosphorus(OR=7.433,95%CI 1.558-35.470,P=0.012)were two independent risk factors for cardiac valve calcification in patients with continuous ambulatory peritoneal dialysis,and the decrease of soluble klotho(OR=0.310,95%CI 0.108～0.891,P=0.030)was another independent risk factor as well.7.Receiver operator characteristic curves indicated that to predict cardiac valve calcification in patients with continuous ambulatory peritoneal dialysis,the optimal cut off point of soluble fibroblast growth factor-23 and soluble klotho was 2 172.64pg/mL(sensitivity was 91.3%,specificity was 91%)and 231.88pg/mL(sensitivity was 88.8%,specificity was 92.5%),respectively.Conclusions:1.The incidence of cardiac valve calcification was high in continuous ambulatory peritoneal dialysis patients.The risk of cardiac valve calcification in peritoneal dialysis patients was related to fibroblast growth factor-23,soluble klotho,age,dialysis age,serum creatinine,corrected calcium,phosphorus,serum alkaline phosphatase,parathyroid hormone,urea clearance index,residual renal function and so on.2.The level of soluble fibroblast growth factor-23 was elevated and the level of soluble klotho was decreased significantly in continuous ambulatory peritoneal dialysis patients with cardiac valve calcification.3.The increase of soluble fibroblast growth factor-23 and serum phosphorus,and the decrease of soluble klotho were independent risk factors for cardiac valve calcification in continuous ambulatory peritoneal dialysis patients.4.Soluble fibroblast growth factor-23 and soluble klotho can be used to diagnose cardiac valve calcification in patients with continuous ambulatory peritoneal dialysis with high specificity and sensitivity.