Kidney Week

Abstract: TH-PO787

FGF23 and Mortality in a Large Cohort of Prevalent Hemodialysis Patients: Results from the J-DOPPS

Session Information

• Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular - I
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

• Komaba, Hirotaka, Tokai University School of Medicine, Isehara, Japan

Hirotaka Komaba,

• Fuller, Douglas S., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Douglas S. Fuller,

• Taniguchi, Masatomo, Kyushu University, Fukukoka, FUKUOKA, Japan

Masatomo Taniguchi,

• Yamamoto, Suguru, Niigata University, Niigata, niigata, Japan

Suguru Yamamoto,

• Nomura, Takanobu, Kyowa Hakko Kirin Co Ltd, Tokyo, Japan

Takanobu Nomura,

• Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Brian Bieber,

• Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Bruce M. Robinson,

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni,

• Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Japan

Masafumi Fukagawa,

Background

Elevated levels of fibroblast growth factor 23 (FGF23) have been associated with mortality in the pre-dialysis and incident hemodialysis population, but few studies have examined this relationship in a large cohort of maintenance hemodialysis patients. We analyzed the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS) data to explore the association between FGF23 levels and all-cause mortality among maintenance hemodialysis patients.

Methods

We included 1,122 maintenance hemodialysis patients from the J-DOPPS phase 5 (2012-2015) who had FGF23 measurements. We evaluated the association between FGF23 levels and all-cause mortality using Cox regression adjusted for potential confounders.

Results

At study enrollment, the median FGF23 level was 2,113 (IQR, 583-6,880) pg/ml. These levels remained essentially unchanged among patients with repeated measurements. During 3-year follow-up, 154 of the 1,122 participants died. FGF23 was associated with younger age and fewer comorbidities. After adjustment for these plus dialysis vintage, albumin, and creatinine, FGF23 was positively associated with death (HR per unit increase in log-transformed FGF23, 1.17; 95% CI, 1.04-1.32). Although median FGF23 was higher in patients with longer dialysis vintage, the adjusted association between FGF23 and mortality was less pronounced as the duration of dialysis increased.

Conclusion

FGF23 was positively associated with mortality in chronic hemodialysis patients. However, this association was less pronounced in patients with longer dialysis vintage. These results suggest that long-term hemodialysis patients may be less susceptible to the toxic effects of FGF23, or correlated biological processes.

Funding

• Commercial Support – Kyowa Hakko Kirin, Amgen, Baxter Healthcare, AstraZeneca, Hexal AG, Janssen, Keryx, Proteon, Relypsa, Roche, Vifor Fresenius Medical Care Renal Pharma