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High Fibroblast Growth Factor 23 Levels Associated With Low Hemoglobin Levels in Patients With Chronic Kidney Disease Stages 3 and 4

机译：慢性肾脏病3、4期患者的高成纤维细胞生长因子23水平与低血红蛋白水平相关

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In chronic kidney disease (CKD), decreased erythropoietin production, low serum active vitamin D levels, and high renin-angiotensin-aldosterone activities had been regarded as major causes of renal anemia. At present, no clinical data are available to elucidate the association between renal anemia and fibroblast growth factor 23 (FGF23) levels in CKD. This study aimed to access whether FGF23 is involved in the pathogenesis of renal anemia.This cross-sectional observational study included 53 stable outpatients with CKD stages 3 and 4. Our primary predictor was serum FGF23 levels and outcome was hemoglobin levels. Measurements contained hemoglobin, FGF23, 25-hydroxyvitamin D, intact parathyroid hormone, plasma renin, serum aldosterone, HbA1C levels, lipid and iron profiles, and serum and urine electrolytes.Mean age of our patients was 66.4 ± 12.8 (SD) years, mean estimated glomerular filtration rate 33.5 ± 13.9 mL/min/1.73 m2, median FGF23 level 200 (25th–75th percentile, 124–303) pg/mL, vitamin D level 19.5 (25th–75th percentile, 14.0–25.9) ng/mL, and hemoglobin level 12.7 (25th–75th percentile, 10.7–13.75) g/dL. Even after adjusting multiple variables, lower hemoglobin levels correlated significantly with FGF23 levels that were higher than the median value (>200 pg/mL). Moreover, after adjusting for aldosterone, but not 25-hydroxyvitamin D, it decreased the association with FGF23 that higher than median level and hemoglobin levels. We also observed a significant decrease of hemoglobin level in the higher FGF23 group who had a diabetes history.High FGF23 levels were observed to be associated with low hemoglobin levels, which may be partially mediated through the effects of serum aldosterone levels in our patients with CKD stages 3 and 4. Furthermore, we also presumed that diabetes itself may have an impact on the loop among FGF23, hemoglobin, and aldosterone levels in these CKD patients.
机译：在慢性肾脏疾病（CKD）中，促红细胞生成素的产生减少，血清活性维生素D含量低和肾素-血管紧张素-醛固酮活性高被认为是肾性贫血的主要原因。目前，尚无临床数据阐明CKD中肾性贫血与成纤维细胞生长因子23（FGF23）水平之间的关系。这项研究旨在探讨FGF23是否参与肾性贫血的发病机制。这项横断面观察性研究包括53名CKD 3和4期稳定的门诊患者。我们的主要预测指标是血清FGF23水平和结局是血红蛋白水平。测量结果包括血红蛋白，FGF23、25-羟基维生素D，完整的甲状旁腺激素，血浆肾素，血清醛固酮，HbA1C水平，脂质和铁谱以及血清和尿液电解质。我们患者的平均年龄为66.4±12.8（SD）岁，平均肾小球滤过率估计值33.5±13.9mL / min /1.73μm 2 ，FGF23中位数为200（25-75％，124-303）pg / mL，维生素D为19.5（25-75％， 14.0-25.9）ng / mL，血红蛋白水平12.7（第25-75％，10.7-13.75）g / dL。即使调整了多个变量，较低的血红蛋白水平也与高于中值（> 200µpg / mL）的FGF23水平显着相关。此外，在调整了醛固酮而不是25-羟基维生素D之后，它降低了与FGF23的联系，高于中值水平和血红蛋白水平。我们还观察到有糖尿病史的较高FGF23组的血红蛋白水平显着下降，观察到高FGF23水平与低血红蛋白水平相关，这可能部分是由CKD患者血清醛固酮水平的影响所介导的第三和第四阶段。此外，我们还假定糖尿病本身可能会影响这些CKD患者的FGF23，血红蛋白和醛固酮水平之间的循环。

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