The Relation between Fibroblast Growth Factor-23 and Left Ventricular Mass and Geometry in Hemodialysis Patients

INTRODUCTION : Chronic kidney disease (CKD) is a major health problem that is associated with an increased risk of cardiovascular mortality and morbidity. Left ventricular hypertrophy (LVH) was found to be commonly met in patients with CKD. Hemodialysis patients with LVH mass was found to have poorer prognosis.Fibroblast growth factor-23 (FGF-23) is a circulating hormone, secreted by osteocytes and osteoblasts, and plays a critical role in regulation of bone and mineral metabolism. FGF-23 was found to be markedly elevated in CKD patients on regular dialysis and was found to be associated with LVH in these patients. However, little data are available about the relation between FGF-23 and different types of LVH and different LV geometries. AIM OF THE WORK : It was to study the relation between FGF-23 levels and LV mass and geometry in CKD patients under regular hemodialysis. PATIENTS AND METHODS : One hundred patients with CKD under regular hemodialysis were included in our study. Patients were excluded from the study if they had one or more of the following: known coronary artery disease, previous myocardial infarction or revascularization, significant valvular or congenital heart disease, or congestive heart failure. After giving an informed written consent, all subjects were subjected to full history taking; thorough clinical examination; complete 12-leads electrocardiography; echocardiography with measuring of of left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), fraction of shortening (FS), ejection fraction (EF), interventricular septal thickness (IVST), posterior wall thickness (PWT), left ventricular mass and mass index (LVMI), left ventricular end-diastolic volume and volume index (LVEDVI); laboratory tests measuring of blood urea and serum creatinine, serum electrolytes, complete blood count, lipid profile, and FGF-23 level. According to FGF-23 level were divided into two groups: Group I; patients with FGF-23 level < 123.5 RU/mL, Group II; patients with FGF-23 level ? 123.5 RU/ml. RESULTS: Regarding clinical and laboratory data there was no significant difference between the study groups except for a significantly higher phosphorus level in patients with FGF-23 level ? 123.5 RU/ml.Regarding echocardiographic data, LVEDD, LVESD, IVST, PWT, LVMI, and LVEDVI, were significantly higher in patients with FGF-23 level ? 123.5 RU/ml. Also, there were significantly more patients with LVH and with thick and dilated LVH among patients with FGF-23 level ? 123.5 RU/ml.There was a significant positive correlation between FGF-23 level and LVMI (r = 0.446, p <0.00001). Also, there was a significant positive correlation between FGF-23 level and LVEDVI (r = 0.454, p <0.00001). CONCLUSION: Among ESRD patients on regular hemodialysis, those with higher FGF-23 levels seem to have significantly higher LV mass, LV end diastolic volume, more incidence of LVH, and more incidence of thick and dilated LVH.