Serum Fibroblast Growth Factor-23 Levels and Progression of Aortic Arch Calcification in Non-Diabetic Patients on Chronic Hemodialysis

Aim: Vascular calcification is a cause of cardiovascular death in hemodialysis (HD) patients. The aim of the present study was to evaluate the relationship between the progression of aortic arch calcification (AoAC) and serum fibroblast growth factor (FGF)-23. Methods: The enrolled study subjects were 127 (83 men and 44 women) HD patients. Calcification of the aortic arch was semiquantitatively estimated with a score (AoACS) on plain chest radiology. Change in AoACS (Delta AoACS) was obtained by subtracting the baseline AoACS value from the follow- up AoACS value. The second assessment was performed from 5 years after the first determination. Results: The percentage of male gender in non-progressors (58.5%) was lesser than in regressors (60.0%) and progressors (74.6%). In addition, the dialysis duration in regressors (14.1 +/- 5.1 years) was shorter than in non-progressors (19.5 +/- 7.0 years) and progressors (16.8 +/- 7.5 years). Interestingly, the serum FGF-23 level in regressors (39225.5 +/- 9247.9 pg/mL) was significantly higher than in non-progressors (12896.5 +/- 26323.5 pg/ mL) and progressors (14062.4 +/- 18456.8 pg/mL). Multiple regression analyses showed male gender (beta value = 0.969, F = 5.092, p = 0.0192), serum levels of albumin (beta value =-1.395, F = 4.541, p = 0.0296) and log FGF-23 (beta value =-0.001, F = 7.273, p = 0.0115) to be significant independent determinants of Delta AoACS. Conclusion: Changes in AoAC evaluated by using a simple chest radiograph are associated with serum FGF-23 levels. Excess accumulation of FGF-23 in serum may enable to inhibit the calcification process in vessel walls in chronic HD patients.