The relation between fibroblast growth factor 23 and left ventricular hypertrophy in non dialysis patients with chronic kidney disease / 中国医师进修杂志

ABSTRACT

Objective To investigate the relation between serum level of fibroblast growth factor (FGF)-23 and left ventricular hypertrophy in non dialysis patients with chronic kidney disease (CKD). Methods One hundred and twenty-four non dialysis patients with CKD were selected. Among them 34 cases were CKD 1-2 stage (CKD 1-2 stage group), 50 cases were CKD 3-4 stage (CKD 3-4 stage group), and 40 cases were CKD 5 stage (CKD 5 stage group). Thirty-two subjects of healthy people were selected as control group. The serum FGF-23, urea nitrogen, creatinine, calcium, phosphorus, intact parathyroid hormone (iPTH) and hemoglobulin levels were measured. The cardiac structural parameters were assessed by Doppler echocardiography, which included left ventricular end-diastolic diameter (LVDd), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF). Left ventricular mass index (LVMI) was calculated by Devereux formula. The patients were diagnosed as left ventricular hypertrophy according to LVMI (male ≥ 125 g/m2, female ≥ 110 g/m2). The relation between FGF-23 and left ventricular hypertrophy was analyzed. Results Among the patients with CKD, left ventricular hypertrophy was in 46 cases (hypertrophy group), non left ventricular hypertrophy was in 78 cases (hypertrophy group), and the incidence of left ventricular hypertrophy in patients with CKD was 37.1% (46/124). The lgFGF- 23, lgiPTH and phosphorus levels in hypertrophy group were significantly higher than those in non hypertrophy group1.69 ± 0.33 vs. 1.50 ± 0.27, 1.98 ± 0.45 vs. 1.74 ± 0.32 and (1.50 ± 0.59) mmol/L vs. (1.27 ± 0.39) mmol/L, the calcium, albumin, hemoglobulin and LVEF levels were significantly lower than those in non hypertrophy group(2.06 ± 0.24) mmol/L vs. (2.17 ± 0.20) mmol/L, (35.76 ± 4.18) g/L vs. (39.74 ± 5.73) g/L, (96.65 ± 22.66) g/L vs. (117.15 ± 27.67) g/L and (59.62 ± 12.02)%vs. (67.76 ± 6.69)%, and there were statistical differences (P0.05). The incidences of left ventricular hypertrophy and LVMI in CKD 1-2 stage group, CKD 3-4 stage group and CKD 5 stage group were significantly higher than those in control group11.8%(4/34), 36.0%(18/50) and 60.0% (24/40) vs. 3.1% (1/32), (91.18 ± 16.17), (111.25 ± 27.89) and (124.82 ± 24.80) g/m2 vs. (84.41 ± 13.77) g/m2, those indexes in CKD 3-4 stage group, CKD 5 stage group were significantly higher those in CKD 1-2 stage group, and those indexes in CKD 5 stage group were significantly higher than those in CKD 3-4 stage group, and there were statistical differences (P0.05). Multiple linear regression analysis result showed that LVMI (Y) was negatively correlated with hemoglobulin (X1) and LVEF (X2), and the regression equation was Y = 255.201- 0.424 X1- 1.092 X2. Conclusions The incidence of left ventricular hypertrophy increases gradually with the decline of renal function in non dialysis patients with CKD. The serum level of FGF-23 is related to left ventricular hypertrophy and the degree of heart failure in non dialysis patients with CKD. Anemia and cardiac function state are closely related to left ventricular hypertrophy in non dialysis patients with CKD.