Effect of serum fibroblast growth factor-23 on phosphate metabolism and related factors in peritoneal dialysis patients

doi:10.3877/cma.j.issn.1674-0785.2019.09.003

Abstract

Abstract:

Objective

To evaluate the effects of serum fibroblast growth factor-23 (FGF23) on phosphate metabolism in peritoneal dialysis (PD) patients, and to identify the factors influencing serum FGF23 in PD patients.

Methods

A cross-sectional study was performed in 92 patients with stable PD therapy for more than 3 months at the Chengdu Second Affiliated Hospital of Chongqing Medical University. The patients were divided into two groups according to the median serum FGF23 concentration 821 pg/ml [(476.90-1775.61) pg/ml]: low-level group (<821 pg/ml) and high-level group (≥821 pg/ml). Dietary protein, dietary phosphate, serum phosphate, peritoneal phosphate clearance, residual renal phosphate clearance, total phosphate clearance, serum parathyroid hormone (iPTH), and residual renal function (RFF) were analyzed. Based on dialysate to plasma creatinine ratio (D/Pcr), 32 patients were divided into either subgroup A (high average transport+ high transport) or subgroup B (low average transport+ low transport).

Results

Dietary protein and dietary phosphate in the high-level group were significantly higher than those of the low-level group (P<0.05). Serum phosphate, iPTH, and serum calcium were also significantly higher in the high-level group (P<0.05). Peritoneal phosphate clearance, urinary phosphate clearance, total phosphate clearance, Kt/V, and weekly creatinine clearance were significantly lower in the low-level group (P<0.05). The clearance of FGF23 in subgroup A was significantly lower than that of group B (P=0.044). Multiple stepwise regression analysis indicated that serum phosphate level, total phosphate clearance, Log(iPTH), residual kidney function, and dialysis time were independent risk factors for elevated serum FGF23 (P<0.05).

Conclusion

PD patients with higher levels of serum FGF23 have a lower total phosphate clearance rate, higher dietary phosphate intake, and higher serum phosphate levels. Residual renal clearance of phosphate and peritoneal clearance of phosphate are related to serum FGF23. Patients with relatively high peritoneal transport function have lower peritoneal FGF23 clearance. Serum phosphate, total phosphate clearance, Log(iPTH), residual renal function, and dialysis time are independent risk factors for elevated serum FGF23 levels in PD patients.

Key words: Peritoneal dialysis, Fibroblast growth factor, Phosphorus metabolism disorders

Rong Gong, Tianzhao Han, Ying Shu, Jingjing Pi, Min Liu. Effect of serum fibroblast growth factor-23 on phosphate metabolism and related factors in peritoneal dialysis patients[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(09): 653-658.

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Figures/Tables 5

References 16

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组别	例数	男性［例（%）］	年龄（岁）	透析龄（月）	体表面积（m²）	合并糖尿病［例（%）］	酮酸摄入量（g/d）	碳酸钙摄入量（g/d）
高水平组	46	22（47.83）	47.9±13.7	22（16~36）	1.63±0.21	11（23.91）	5.78±3.50	1.00（0.00~1.50）
低水平组	46	29（63.04）	45.0±13.7	10（6~22）	1.66±0.19	13（28.26）	5.19±3.40	0.86（0.00~1.50）
统计值	?	χ²=0.316	t=0.796	Z=-3.687	t=-0.800	χ²=0.358	t=-0.910	Z=-0.583
P值	?	0.574	0.435	<0.001	0.425	0.549	0.365	0.564
组别	例数	蛋白质摄入量［g?kg/（IBW?d）］	优质蛋白质摄入量［g?kg/（IBW?d）］	鸡蛋白占比（%）	血白蛋白水平（g/L）	饮食磷摄入量［g?kg/(IBW?d)］		iPTH水平（ng/L）
高水平组	46	1.10±0.20	0.63±0.16	11.94±7.20	36.96±3.24	13.33±2.50		419（309~544）
低水平组	46	1.00±0.21	0.62±0.16	12.24±7.20	38.21±3.46	11.80±3.31		191（133~280）
统计值	?	t=-3.532	t=-2.766	t=0.100	t=1.148	t=-2.377		Z=-6.899
P值	?	0.001	0.007	0.919	0.254	0.019		<0.001

组别	例数	男性［例（%）］	年龄（岁）	透析龄（月）	体表面积（m²）	合并糖尿病［例（%）］	酮酸摄入量（g/d）	碳酸钙摄入量（g/d）
高水平组	46	22（47.83）	47.9±13.7	22（16~36）	1.63±0.21	11（23.91）	5.78±3.50	1.00（0.00~1.50）
低水平组	46	29（63.04）	45.0±13.7	10（6~22）	1.66±0.19	13（28.26）	5.19±3.40	0.86（0.00~1.50）
统计值	?	χ²=0.316	t=0.796	Z=-3.687	t=-0.800	χ²=0.358	t=-0.910	Z=-0.583
P值	?	0.574	0.435	<0.001	0.425	0.549	0.365	0.564
组别	例数	蛋白质摄入量［g?kg/（IBW?d）］	优质蛋白质摄入量［g?kg/（IBW?d）］	鸡蛋白占比（%）	血白蛋白水平（g/L）	饮食磷摄入量［g?kg/(IBW?d)］		iPTH水平（ng/L）
高水平组	46	1.10±0.20	0.63±0.16	11.94±7.20	36.96±3.24	13.33±2.50		419（309~544）
低水平组	46	1.00±0.21	0.62±0.16	12.24±7.20	38.21±3.46	11.80±3.31		191（133~280）
统计值	?	t=-3.532	t=-2.766	t=0.100	t=1.148	t=-2.377		Z=-6.899
P值	?	0.001	0.007	0.919	0.254	0.019		<0.001

组别	例数	血磷水平（mmol/L）	残肾磷清除率［L/（周?1.73 m²）］	腹膜磷清除率［L/（周?1.73 m²）］	总磷清除率［L/（周?1.73 m²）］	D/Pcr	血FGF23水平（pg/ml）
高水平组	46	1.73±0.35	6.56（2.07~8.23）	23.80±6.21	30.60±12.5	0.63±0.12	2310（1220~3926）
低水平组	46	1.62±0.35	8.04（5.70~11.64）	27.60±10.80	35.60±6.21	0.62±0.12	459（389~564）
统计值	?	t=-4.479	Z=3.685	t=0.025	t=2.407	t=0.681	Z=-8.703
P值	?	<0.001	0.0004	0.043	0.018	0.498	<0.001

组别	例数	血磷水平（mmol/L）	残肾磷清除率［L/（周?1.73 m²）］	腹膜磷清除率［L/（周?1.73 m²）］	总磷清除率［L/（周?1.73 m²）］	D/Pcr	血FGF23水平（pg/ml）
高水平组	46	1.73±0.35	6.56（2.07~8.23）	23.80±6.21	30.60±12.5	0.63±0.12	2310（1220~3926）
低水平组	46	1.62±0.35	8.04（5.70~11.64）	27.60±10.80	35.60±6.21	0.62±0.12	459（389~564）
统计值	?	t=-4.479	Z=3.685	t=0.025	t=2.407	t=0.681	Z=-8.703
P值	?	<0.001	0.0004	0.043	0.018	0.498	<0.001

组别	例数	Kt/V（周）	WCC ［L/（周?1.73 m²）］	RRF ［ml/（min?1.73 m²）］	二氧化碳结合力（mmol/L）	超滤量（ml/d）	血钙（mmol/L）	尿量（ml/d）
高水平组	46	1.977±0.461	59.47±11.18	3.40±2.38	24.97±0.80	600（500~700）	2.22±0.12	400（300~600）
低水平组	46	1.947±0.471	66.09±11.18	3.54±2.22	24.78±0.81	500（400~700）	2.21±0.16	700（500~1000）
统计值	?	t=2.880	t=2.892	t=5.733	t=1.741	Z=-2.243	t=-2.980	Z=4.746
P值	?	0.005	0.005	<0.001	0.085	0.028	0.004	<0.001

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