Roles Of Fibroblast Growth Factor 21 In Continuous Ambulatory Peritoneal Dialysis Patients And The Clinical Follow-up

Fibroblast growth factor21(FGF-21),composed of 181 amino acids,is a ne wly found member of the family of fibroblast growth factors(FGFs).FGF-21 was discovered to be expressed primarily in the liver and stimulate glucose u ptake in adipocytes.In the recent years,studies have shown that FGF-21 had di agnostic and therapeutic potential in metabolic disorders including diabetes.Ho wever,the research of FGF-21 in chronic kidney disease(CKD)and dialysis re mains in its infancy.Reports about correlation between plasma levels of FGF-21 and complications of CKD patients and continuous ambulatory peritoneal di alysis(CAPD)patients remain lacking.Change of plasma levels of FGF-21 ha s not been reported in Chinese patients.Objective:We aim to explore correlation between plasma levels of FGF-21 and indicators of quality of life in CAPD patients,including general clinical parameters,glucolipid metabolic parameters,inflammation parameters,heart function.We analysis change of FGF-21 level and the correlation between FGF-21 levels during the 1-year dialysis.Method:58 patients undergoing CAPD for more than 3 months with the glomerular filtration rate less than 15ml·min-1.(1.73m2)-1 were recruited.We collected the medical history and general clinical parameters,measured the plasma levels of FGF-21,ADPN,glucolipid metabolism parameters,inflammatory parameters,renal function,peritoneal function,heart function,and conducted a 1-year clinical visit.Then comparison of different groups,difference analysis of plasma FGF-21 in different groups,correlation analysis and mult-variable linear return analysis were performed.Result:(1)General clinical parameters:This study included 58 end-stage renal di sease patients who underwent CAPD(CAPD group),and 1-year clinical follow-up was conducted(the 1st year group).After excluding 4 cases suffering perito nitis,54 cases were further analysed.The primary diseases included chronic ne phritis(59.26%),benign ephrosclerosis(12.96%),obstructive nephropathy(12.96%),d iabetic nephropathy(9.26%),polycystic kidney(3.70%),and gouty nephropathy(1.85%).(2)Comparison of different groups:The levels of plasma FGF-21(P=0.000),residual renal function(RRF)(P=0.000),hemoglobin(Hb)(P=0.034),C-reactive pro tein(CRP)(P-=0.009),in CAPD group are higher than that in the 1st year group.The levels of plasma adiponectin(ADPN)(P=0.000),creatinine(Cr)(P=:0.000),calci um(Ca)(P--0.007),left ventricular mass(LVM)(P=0.006),left ventricular mass inde x(LVMI)(P=0.004),in the 1st year group were higher than that in CAPD gro up.(3)Difference analysis of plasma FGF-21 in different groups:Plasma FGF-21 levels in CAPD patients with left ventricular hypertrophy(LVH)were significantly higher than those without left ventricular hypertrophy(P<0.05).LVH had no correlation with plasma FGF-21 in the 1st year group.There were no correlations between plasma FGF-21 levels and sex,diabetes or RRF in CAPD patients(P>0.05).(4)Correlation analysis of plasma FGF-21 levels:Bivariate correlation analysis showed that plasma FGF-21 levels had no correlation with any parameters in CAPD patients(P>0.05).Plasma FGF-21 levels significantly decreased over the 1-year follow-up(P<0.05).ADPN,TC,GLU and Hb correlated positively with plasma FGF-21 concentration in the 1st year group(all P<0.05),the change of inflammatory markers(C-reactive protein)correlated positively with variation of FGF-21 levels(P<0.05).Mult-variable linear return analysis showed that no parameters was independently associated with FGF-21(P>0.05).Conclusion:Plasma level of FGF-21 might be a sensitive biomarker for predicting complications of dialysis,including glucose and lipid metabolism disorder,inflammatory state,cardiovascular disease,etc.For patients receiving long-time CAPD,plasma level of FGF-21 might decrease over time.