Elevated serum FGF21 is an independent predictor for adverse events in hemodialysis patients from two large centers: a prospective cohort study

Ren Fail. 2023;45(2):2256414. doi: 10.1080/0886022X.2023.2256414. Epub 2023 Sep 19.

Abstract

Introduction: We explored the relationship and the predictive value of serum fibroblast growth factor 21 (FGF21) with all-cause mortality, major adverse cardiovascular events (MACEs) and pneumonia in hemodialysis (HD) patients.Methods: A total of 388 Chinese HD patients from two HD centers were finally enrolled in this prospective cohort study (registration number: ChiCTR 1900028249) between January 2018 and December 2018. Serum FGF21 was detected. Patients were followed up with a median period of 47 months to record the MACEs and pneumonia until death or 31 December 2022.Results: The incidence of all-cause mortality, MACEs and pneumonia in HD patients were 20.6%, 29.6%, and 34.8%, respectively. The optimal cutoffs for FGF21 to predict all-cause mortality, MACEs and pneumonia were 437.57 pg/mL, 216.99 pg/mL and 112.79 pg/mL. Multivariate Cox regression analyses showed that FGF21, as a categorical variable, was an independent predictor for all-cause mortality, MACEs and pneumonia (HR, 3.357, 95% CI, 2.128-5.295, p < 0.001; HR, 1.575, 95% CI, 1.046-2.371, p = 0.029; HR, 1.784; 95% CI, 1.124-2.830; p = 0.014, respectively). The survival nomogram, MACEs-free survival nomogram and pneumonia-free survival nomogram based on FGF21 constructed for individualized assessment of HD patients had a high C-index with 0.841, 0.706 and 0.734.Conclusion: Higher serum FGF21 is an independent predictor of all-cause mortality, MACEs and pneumonia in HD patients.

Keywords: All-cause mortality; fibroblast growth factor 21; hemodialysis; major adverse cardiovascular events; pneumonia.

MeSH terms

  • East Asian People
  • Fibroblast Growth Factors* / blood
  • Humans
  • Prospective Studies
  • Renal Dialysis* / adverse effects

Substances

  • fibroblast growth factor 21
  • Fibroblast Growth Factors

Grants and funding

Grants supported this work from Young Talent Development Plan of Changzhou Health Commission (2020-028) to Min Li, 333 Personnel Training Project of Jiangsu Province (BRA2020156), Changzhou Key Medical Discipline (CZXK202204) and the Science and Technology Support (Social Development) Project of Bureau of Science and Technology of Changzhou (CE20215024) to Min Yang, Weiya Shi Kidney Disease Research and Development Project, the Clinical Medical Research Fund of Chinese Medical Association, and the CKD-MBD Youth Research Fund to Bin Wang, Clinical Pharmacy Fund Project of Jiangsu Pharmaceutical Association (A202021) to Qing Qian, General Program of Health Commission of Jiangsu Province (M2021064) to Yanfeng Wu. The funding organizations had no role in the design of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors thank the patients and their families involved in the study. This work was supported by Clinical Pharmacy Fund Project of Jiangsu Pharmaceutical Association.