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. 2022 Jun 21:9:912764.
doi: 10.3389/fmed.2022.912764. eCollection 2022.

In-center Nocturnal Hemodialysis Reduced the Circulating FGF23, Left Ventricular Hypertrophy, and All-Cause Mortality: A Retrospective Cohort Study

Meizi Kang  1   2 , Jing Chen  2 , Lingling Liu  2 , Cheng Xue  2 , Xiaojing Tang  2 , Jiayi Lv  2 , Lili Fu  2 , Changlin Mei  2 , Zhiguo Mao  2 , Yawei Liu  2   3 , Bing Dai  2
Affiliations

In-center Nocturnal Hemodialysis Reduced the Circulating FGF23, Left Ventricular Hypertrophy, and All-Cause Mortality: A Retrospective Cohort Study

Meizi Kang et al. Front Med (Lausanne). .

Abstract

Fibroblast growth factor 23(FGF23) is the most important biomarker and pathogenic factor in Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). In the moderate and severe stages of chronic renal failure, abnormally elevated circulating FGF23 can lead to some complications, including myocardial hypertrophy, which is positively correlated with all-cause mortality. However, the circulating FGF23 level of different hemodialysis modalities, the underlying essential regulatory factors, and potential clinical benefits remain to be elucidated. In this retrospective cohort study, 90 in-center nocturnal hemodialysis (INHD) and 90 matched conventional hemodialysis (CHD) patients were enrolled. The complete blood count, intact FGF23(iFGF23), calcium, phosphorus, PTH, and other biochemical and echocardiographic parameters of INHD and CHD patients were collected and analyzed at 1-year follow-up. The all-cause mortality was recorded during the 7-year follow-up. Furthermore, the regulatory factors of iFGF23 and its association with echocardiographic parameters and mortality were investigated by multivariate regression. The levels of iFGF23 and serum phosphate in patients undergoing INHD were significantly lower than those in patients undergoing CHD. The left ventricular volume index (LVMI) in patients with INHD was significantly attenuated and positively correlated with the drop of serum iFGF23. The INHD group had reduced all-cause mortality compared to the CHD group. Multivariate analysis showed that iFGF23 was positively correlated with serum calcium, serum phosphorus, and calcium-phosphate product. The calcium-phosphate product is an independent determining factor of serum iFGF23. Compared with the CHD group, the INHD group presented with a significantly reduced circulating iFGF23 level, which was closely associated with attenuation of left ventricular hypertrophy, but INHD reduced all-cause mortality in an FGF23 independent manner.

Keywords: Chronic Kidney DiseaseMineral and Bone Disorder (CKD-MBD); calcium-phosphate product; fibroblast growth factor 23; in-center nocturnal hemodialysis; left ventricular hypertrophy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Univariate linear correlation between phosphate (A), calcium (B), calcium-phosphate product (C), and FGF23.
Figure 2
Figure 2
Univariate linear correlation between lnFGF23 and LVMI in INHD group (A), CHD group (B), and within overall patients (C) (Figure 3).
Figure 3
Figure 3
(A) Comparison of systolic blood pressure between patients undergoing INHD and CHD. (B) Comparison of volume control between patients undergoing INHD and CHD. *P < 0.05.
Figure 4
Figure 4
The Kaplan–Meier survival curves comparing patients undergoing INHD and CHD in terms of mortality.
See this image and copyright information in PMC

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