Fibroblast Growth Factor-23 importance as a prognostic factor in hemodialysis patients

Background: Initial complications evident in chronic kidney disease (CKD) are enhanced levels of Fibroblast growth factor 23 (FGF23) and phosphate homeostasis disorders. An increase in FGF23 is a highly sensitive indicator of phosphate toxicity and end-organ toxicity in the heart. Objective: The objective of the current research was to explore the correlation between the quantity of FGF23 and bonemineral metabolism, anemia left ventricular hypertrophy (LVH), and dysfunction (LVEF). Methods: This research was executed at the nephrology units, dialysis department / Baghdad Teaching Hospital, and Basrah Teaching Hospital from 1st of January 2021 to 1 of March 2022. 60 patients undergoing hemodialysis for a minimum of six months were recruited for the research. Parameters assessed included hematocrit (Htc), hemoglobin (Hb), phosphorus (P), calcium (Ca), corrected albumin, and whole parathyroid hormone (iPTH). We further calculated if any correlation existed between these parameters and FGF23 levels. We also conducted left ventricular echocardiography of the recruited patients to evaluate the relation between FGF23, LVH, and LVEF. Results: We found a statistically significant positive correlation between serum FGF23 levels and iPTH (P < 0.001), and Ca values (P < 0.001). However, we were unable to find a substantial correlation between the levels of FGF23 and Hb (P = 0.518) and Htc (P = 0.377). FGF23 and LVH were also statistically correlated (P < 0.001). A significant negative correlation of FGF23 was found with LVEF showing a decrease in LVEF with increasing levels of FGF23 (P < 0.001). Conclusion: Elevated serum FGF-23 levels in hemodialysis patients showed a significant correlation with various studied parameters indicating its role in the development of hyperparathyroidism. Noticeably, our data showed a positive correlation between FGF23 and LVH and a negative correlation between FGF23 and LVEF suggesting that FGF23 is sufficient to forecast of overall death rate in patients suffering from CKD.