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      Fibroblast Growth Factor 23 Trajectories in Chronic Hemodialysis Patients: Lessons from the HEMO Study

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          Abstract

          Background: Long-term patterns of fibroblast growth factor 23 (FGF23) are poorly characterized among dialysis patients. Objectives: To identify different FGF23 trajectories and determine clinical factors that predict distinct FGF23 trajectories and whether FGF23 trajectories differ in regard to their associations with all-cause mortality among prevalent hemodialysis patients. Methods: The HEMO study was a randomized multicenter study evaluating the effects of high-dose vs. standard-dose and high-flux vs. low-flux hemodialysis on mortality. We measured intact FGF23 levels in stored serum samples at baseline and annually among 919 HEMO participants and identified FGF23 trajectories using group-based modeling. Logistic regression determined predictors of trajectories. Cox regression models evaluated the association between trajectory and all-cause mortality. Results: We identified 5 distinct FGF23 trajectory groups during the initial 24 months: low stable, low increasing, elevated increasing, elevated decreasing, and elevated stable. In multivariable models, diabetes, high dose dialysis, no venous catheter, low serum calcium, phosphorus, and interleukin-6, no vitamin D analog use, and greater residual kidney function were associated with the low stable trajectory group compared to the elevated stable group. High flux dialysis, no venous catheter, and low serum phosphorus and 25-hydroxyvitamin D were associated with the elevated decreasing trajectory group compared to the elevated stable group. After full adjustment, the low stable trajectory group was associated with reduced mortality (hazard ratio [HR] 0.61; 95% CI ­0.41–0.91) compared to the elevated stable trajectory group. Conclusions: We identified 5 distinct FGF23 trajectories over 24 months among HEMO study participants including a decreasing trajectory. The low stable FGF23 trajectory was associated with a reduced HR of all-cause mortality.

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          Author and article information

          Journal
          AJN
          Am J Nephrol
          10.1159/issn.0250-8095
          American Journal of Nephrology
          S. Karger AG
          0250-8095
          1421-9670
          2019
          April 2019
          28 February 2019
          : 49
          : 4
          : 263-270
          Affiliations
          [_a] aRenal Section, Medical Service, Veteran Affairs Eastern Colorado Health Care System, Denver, Colorado, USA
          [_b] bDivision of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
          [_c] cDivision of Nephrology and Hypertension, Department of Medicine and Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
          [_d] dDivision of Nephrology and Hypertension, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
          [_e] eRenal Section, Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
          [_f] fDivision of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
          Author notes
          *Anna Jovanovich, Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Denver Anschutz Medical Campus, 13199 East Montview Blvd., Suite 495, Aurora, CO 80045 (USA), E-Mail anna.jovanovich@ucdenver.edu
          Article
          497445 PMC6469501 Am J Nephrol 2019;49:263–270
          10.1159/000497445
          PMC6469501
          30820005
          037f0289-5c8b-4161-9869-54d9f6d4e4d0
          © 2019 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          History
          : 15 November 2018
          : 01 February 2019
          Page count
          Figures: 1, Tables: 3, Pages: 8
          Categories
          Patient-Oriented, Translational Research: Research Article

          Cardiovascular Medicine,Nephrology
          Hemodialysis,Trajectories,Fibroblast growth factor 23
          Cardiovascular Medicine, Nephrology
          Hemodialysis, Trajectories, Fibroblast growth factor 23

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