The Relationship Between Serum FGF23 Level And Calcium-phosphorus Metabolism And Clinic Relevance In Dialysis Patients With End-stage Renal Disease

Objectives:In this study,we investigated the correlation between serum fibroblast growth factor 23(FGF23)levels in patients with end-stage renal disease(ESRD)with different dialysis modalities.The relationship between serum FGF23 and calcium-phosphorus metabolism and clinic relevance.Methods:This study screened 160 patients receiving dialysis treatment in our hospital from May 2018 to December 2018,and divided them into two groups according to different dialysis methods.Eighty patients with continuous non-bed peritoneal dialysis(CAPD)were in CAPD group and eighty patients with maintenance hemodialysis(MHD)were in MHD group.Subjects in the above two groups were selected according to inclusion and exclusion criteria.After qualification,63 patients in CAPD group and 59 patients in MPD group entered the final analysis.Analysis of two groups of patients serum FGF23 level differences Other indicators were compared between the two groups.The influencing factors of serum FGF23 were analyzed.According to the combination of cardiovascular disease(CVD),it was divided into CVD group and NCVD(Noncardiovascular disease)group,and the difference of FGF23 level between the two groups was analyzed and compared.The influencing factors of serum CVD were analyzed.Results:(1)Comparison of general conditions of patients in CAPD group and MHD group: there was no statistically significant difference between CAPD group and MHD group in the distribution of gender,age,dialysis age,primary kidney disease(diabetic nephropathy,non-diabetic nephropathy)and other basic conditions(P >0.05).(2)Comparison of laboratory and clinical indicators between CAPD group and MHD group:(1)Serum FGF23 level of CAPD group was lower than that of MHDgroup(P < 0.05);(2)Serum phosphorus and serum albumin in CAPD group were significantly lower than that in MHD group(P < 0.001);(3)Serum iPTH of CAPD group was lower than that of MHD group(P < 0.05);(4)There was no significant difference in serum Klotho protein level and serum calcium level between the two groups(P > 0.05);(5)The 24-hour urine volume of patients in CAPD group was significantly higher than that in MHD group(P< 0.05);(6)The percentage of MHD patients with CVD(89.8%)was greater than that of CAPD patients with CVD(63.5%),and there was a statistical difference(P<0.05).(3)The comparison of serum calcium compliance rate,phosphorus compliance rate and serum iPTH compliance rate between CAPD group and MHD group showed that the CAPD group had a higher compliance rate,including 44.4% serum calcium compliance rate,44.4% serum phosphorus compliance rate and 42.9% serum iPTH compliance rate in the CAPD group;and 22.0% serum calcium compliance rate,20.3% serum phosphorus compliance rate and 22.0% serum iPTH compliance rate in the MHD group.The difference of the compliance rate between the two groups was statistically significant(P < 0.05).(4)Comparison of serum FGF23 levels between serum calcium,serum phosphorus and serum iPTH standards and non-standards: There was no significant difference in FGF23 level between the group with and without calcium(P> 0.05).Serum FGF23 level was lower in the phosphorus standard group(P< 0.05).The Serum FGF23 level of serum iPTH standard group was lower(P<0.05).(5)Correlation analysis of serum FGF23: serum FGF23 and serum phosphorus in dialysis patients showed a positive correlation(r=0.716,P=0.000).It was positively correlated with serum iPTH(r=0.180,P=0.049).It was negatively correlated with serum calcium(r=-0.179,P=0.048).It was negatively correlated with serum klotho protein(r=-0.273,P=0.002).There was no correlation with serum albumin(r=0.046,P=0.615).(6)Correlation analysis of CVD : he patients were divided into 2 groups according to the combination of CVD or not,with 93 cases patients with CVD,29 patients were NCVD,Comparing the FGF23 level between the two groups,the FGF23 level of the CVD group was higher,and the difference was statisticallysignificant(P < 0.05).Analysis the influence factors of CVD: whether to merge CVD as dependent variable,FGF23,serum phosphorus,serum calcium and serum iPTH as independent variables,binary Logistic regression analysis,the results showed that serum FGF23(B value = 0.010,P = 0.003),serum phosphorus(B value = 1.234,P =0.033)are independent risk factors for CVD.Conclusion:Serum FGF23 level of ESRD dialysis patients is closely related to calcium-phosphorus metabolism and clinical prognosis,and it is affected by many factors such as dialysis mode,in vivo mineral metabolism,urine volume,etc.Compared with MHD,CAPD can better control FGF23 level and calcium-phosphorus metabolism,and has certain advantages in cardiovascular protection.CAPD can protect residual renal function more effectively;Serum FGF23 was positively correlated with serum phosphorus and serum iPTH,and negatively correlated with serum calcium and serum Klotho protein in ESRD dialysis patients.There was no significant correlation with serum albumin level.Serum FGF23 was closely related to CVD,and the level of serum FGF23 was higher in patients in the combined CVD group.Serum FGF23 and serum phosphorus were factors affecting CVD.It is recommended that serum FGF23 be used as an indicator to judge the mineral metabolic disorder and to evaluate the clinical therapeutic effect,as well as a commonly used clinical detection index,so as to provide the best plan for individual treatment.