Fp617correlation Between Hypervolemia, Left Ventricular Hypertrophy and Fibroblast Growth Factor 23 in Hemodialysis Patients

Abstract

Introduction and Aims: Left ventricular hypertrophy is commonly encountered in the patients with chronic renal failure. Fibroblast Growth Factor (FGF) 23 is correlated with increased atherosclerosis and endothelial dysfunction in each stage of chronic renal failure. The aim of our study is to investigate the correlation between left ventricular hypertrophy, interdialytic volume increase and FGF-23 in the patients on a chronic hemodialysis program. Methods: A total of 97 chronic hemodialysis patients were included in the study. Human FGF-23 ELISA kit was used for FGF-23 analysis of predialysis blood samples.Echocardiographic evaluation was performed in all of the patients after dialysis. Left Ventricular Mass Index (LVMI) was calculated by using Devereux Formula. Based on the data obtained from the study, the corelations between LVMI, FGF-23 levels, amounts of inreased interdialytic fluid gains, blood pressure changes and the other biochemical ve clinical parameters were investigated. Results: Mean age of the patients was 64,43±11,28 years (M/F: 47/50) and mean LVMI of the patients was determined to be 184,41±48,62. LVMI of the patients with daily urine output > 250 mL was found to be significantly lower. Positive correlation between predialysis systolic blood pressure, predialysis diastolic blood pressure, predialysis mean arterial blood pressure and LVMI measurements was also highly significant ( p<0,01). The correlation between mean interdialytic volume excess and LVMI measurements of the patients at a level of 45,9% was found to be highly statistically significant (r=0,459; p<0,01). Positive correlation between FGF-23 levels and LVMI measurements of the patients determined to have a mean level of FGF-23 as 159,79 ±134,99 ng/L was found to be statistically significant (r=0,322; p<0,01). Again it was determined that FGF-23 levels also increased significantly as the interdialytic fluid volume increased (r=0,326; p<0,05). A positive correlation was also determined between FGF-23 levels and interventricular septum thickness (r=0,238; p<0,05). Predialysis mean arterial blood pressure, predialysis volume overload and presence of diabetes were determined to be independent risk factors on LVMI with multivariate regression analysis. Conclusions:The results of our study showed that hypervolemia developing in chronic hemodialysis patients between two hemodialysis sessions increased both LVMI and FGF-23 values significantly. It is thought that interdialytic volume control exerts positive effects on increased FGF-23 levels considered to be predictor of negative cardiovascular outcomes.