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High C-Terminal Fibroblast Growth Factor-23, Intact Parathyroid Hormone, and Interleukin-6 as Determinants of
Yenny Kandarini1, Gede Wira Mahadita1, Sianny Herawati2
1Department of Internal Medicine, Division of Nephrology and Hypertension, Udayana University Sanglah Hospital, Denpasar, Bali, Indonesia.
Insights
High levels of C-terminal fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (iPTH), and interleukin-6 (IL-6) are linked to valvular calcification in chronic kidney disease patients on hemodialysis. These biomarkers can help determine calcification risk.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Cardiovascular disease (CVD) is the leading cause of mortality in chronic kidney disease-hemodialysis (CKD-HD) patients.
- CVD in CKD-HD patients is frequently linked to mineral bone disorders (MBD), particularly vascular and valvular calcification.
- Biomarkers such as C-terminal fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (iPTH), and interleukin-6 (IL-6) are implicated in CKD-MBD, but their role in valvular calcification requires further investigation.
Purpose of the Study:
- To investigate the association between elevated C-terminal FGF-23, iPTH, and IL-6 levels and the presence of valvular calcification.
- To determine if these biomarkers can serve as determinants of valvular calcification in patients with CKD-MBD undergoing regular hemodialysis.
Main Methods:
- An analytical cross-sectional study was conducted on CKD-HD patients aged 18-60 without prior CVD, malignancy, or diabetes.
- C-terminal FGF-23, iPTH, and IL-6 were quantified using ELISA, chemiluminescent immunometric assay, and sandwich enzyme immunoassay, respectively.
- Valvular calcification of the aortic and mitral valves was assessed via echocardiography, with data analyzed using Chi-squared/Fisher's exact tests and multivariate logistic regression.
Main Results:
- Bivariate analysis revealed significant associations between C-terminal FGF-23 (PR=1.33), iPTH (PR=1.361), and IL-6 (PR=1.2) and valvular calcification.
- Multivariate logistic regression indicated that high C-terminal FGF-23 (exp(B)=16.44), iPTH (exp(B)=33.312), and IL-6 (exp(B)=21.58) were significant determinants of valvular calcification.
Conclusions:
- Elevated levels of C-terminal FGF-23, iPTH, and IL-6 are independently associated with valvular calcification in CKD-MBD patients on hemodialysis.
- These biomarkers may play a crucial role in the development of valvular calcification in this patient population.
- Further research is warranted to explore the therapeutic implications of targeting these biomarkers for preventing valvular calcification in CKD-HD patients.
Purpose:
Biggest cause of death in chronic kidney disease-hemodialysis (CKD-HD) patients is cardiovascular disease (CVD). Cardiovascular disease is often associated with mineral bone disorders (MBD), especially vascular and valvular calcification. Biomarkers such as C-terminal-fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (iPTH), and interleukin-6 (IL-6) were investigated. Only few studies have focused on valvular calcification in CKD-HD patients, with controversial results. The present study aimed to investigate whether high C-terminal-FGF-23, iPTH, and IL-6 can be used as determinants of valvular calcification in CKD-MBD patients undergoing regular HD.
Patients And Methods:
This was an analytical cross-sectional study which involved CKD-HD patients aged 18-60 years with no history of CVD, malignancy, and diabetes mellitus. C-terminal FGF-23 was measured using enzyme-linked immunosorbent assay (ELISA) kit, iPTH using chemiluminescent immunometric method, and IL-6 using sandwich enzyme immunoassay technique. Valvular calcification on aortic and mitral valves was examined with echocardiography. Data analysis was done using Chi-squared test or Fisher's exact test as appropriate and multivariate logistic regression analysis.
Results:
Bivariate analysis with Fisher's exact test showed significant association of prevalence ratio (PR) of C-terminal FGF-23 (PR = 1.33; p = 0.003; CI (1.017-1.748)), iPTH (PR = 1.361; p = 0.002; CI (1.02-1.816)), and IL-6 (PR = 1.2; p = 0.019; CI (1.000-1.446)) with valvular calcification. Multivariate analysis with logistic regression showed high C-terminal FGF-23 (exp (B) value of 16.44; p = 0.045; CI (1.07-252.75)), iPTH (exp (B) value of 33.312; p = 0.016; CI (1.94-571.71)), and IL-6 (exp (B) value of 21.58; p = 0.0381; CI (1.18-394.87)) were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.
Conclusion:
This study demonstrated that high C-terminal FGF-23, iPTH, and IL-6 were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.
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