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Osteoporosis International
Published in: Osteoporosis International 1/2015

01-01-2015 | Original Article

Plasma FGF23 levels and heart rate variability in patients with stage 5 CKD

Authors: L.-N. Zhang, G. Yang, C. Cheng, C. Shen, Y.-Y. Cui, J. Zhang, J.-J. Zhang, Z.-X. Shen, M. Zeng, Y.-F. Ge, B. Sun, X.-B. Yu, C. Ouyang, B. Zhang, H.-J. Mao, J. Liu, C.-Y. Xing, X.-M. Zha, N.-N. Wang

Published in: Osteoporosis International | Issue 1/2015

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Abstract

Summary

Fibroblast growth factor 23(FGF23) is a bone-derived hormone which regulates mineral homeostasis but may also have a role in cardiovascular disease. Here, we found that higher plasma FGF23 was independently associated with decreased heart rate variability in stage 5 CKD patients and parathyroidectomy may reverse these abnormal indicators.

Introduction

Lower heart rate variability (HRV) in patients with chronic kidney disease (CKD) compared with healthy controls is associated with increased risk of cardiovascular disease (CVD). Higher levels of plasma FGF23 also predict higher risk of CVD. Here, we aimed to evaluate the relationship between plasma FGF23 levels and HRV in patients with stage 5 CKD and to investigate longitudinal changes of them together with the correlation between their changes in two severe secondary hyperparathyroidism (SHPT) subgroups with successful parathyroidectomy (PTX) and persistent SHPT.

Methods

This cross-sectional study included 100 stage 5 CKD patients, 78 controls, and a prospective study in two PTX subgroups classified as successful PTX (n = 24) and persistent SHPT (n = 4) follow-up. Blood examination and 24-h Holter monitoring for HRV were measured.

Results

Most HRV indices were lower in stage 5 CKD patients than in healthy controls, and plasma FGF23 levels were higher. In multivariate stepwise regression models, levels of plasma FGF23 and serum parathyroid hormone (PTH) were correlated with HRV. The successful PTX subgroup had significant improvements over baseline in HRV indices. Persistent SHPT subgroup had numerically similar changes in HRV indices. However, plasma FGF23 levels decreased in both subgroups.

Conclusions

Plasma FGF23 levels were higher in CKD patients than in controls, much higher in patients with severe SHPT. FGF23 was independently associated with decreased HRV in stage 5 CKD. Successful PTX may reverse these abnormal indicators and contribute to decreases in the risk of cardiovascular disease.
Appendix
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Literature
1.
Go AS et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305PubMedCrossRef
2.
Collins AJ et al (2014) US renal data system 2013 annual data report. Am J Kidney Dis 63(1 Suppl):A7PubMedCrossRef
3.
KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl, 2009 (113): p. S1-130
4.
Cunningham J, Locatelli F, Rodriguez M (2011) Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol 6(4):913–921PubMedCrossRef
5.
Rubinger D et al (1999) Heart rate variability during chronic hemodialysis and after renal transplantation: studies in patients without and with systemic amyloidosis. J Am Soc Nephrol 10(9):1972–1981PubMed
6.
7.
8.
Shimada T et al (2004) FGF-23 transgenic mice demonstrate hypophosphatemic rickets with reduced expression of sodium phosphate cotransporter type IIa. Biochem Biophys Res Commun 314(2):409–414PubMedCrossRef
9.
10.
Shimada T et al (2004) FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis. J Bone Miner Res 19(3):429–435PubMedCrossRef
11.
Isakova T et al (2011) Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. JAMA 305(23):2432–2439PubMedCentralPubMedCrossRef
12.
13.
Parker BD et al (2010) The associations of fibroblast growth factor 23 and uncarboxylated matrix Gla protein with mortality in coronary artery disease: the heart and soul study. Ann Intern Med 152(10):640–648PubMedCentralPubMedCrossRef
14.
15.
Desjardins L et al (2012) FGF23 is independently associated with vascular calcification but not bone mineral density in patients at various CKD stages. Osteoporos Int 23(7):2017–2025PubMedCrossRef
16.
Charra B et al (1996) Clinical assessment of dry weight. Nephrol Dial Transplant 11(Suppl 2):16–19PubMedCrossRef
17.
Sinha AD, Light RP, Agarwal R (2010) Relative plasma volume monitoring during hemodialysis AIDS the assessment of dry weight. Hypertension 55(2):305–311PubMedCentralPubMedCrossRef
18.
K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis, 2003. 42(4 Suppl 3): p. S1-201
19.
Kara M et al (2010) Evaluation of intraoperative parathormone measurement for predicting successful surgery in patients undergoing subtotal/total parathyroidectomy due to secondary hyperparathyroidism. Laryngoscope 120(8):1538–1544PubMedCrossRef
20.
Fukuta H et al (2003) Prognostic value of heart rate variability in patients with end-stage renal disease on chronic haemodialysis. Nephrol Dial Transplant 18(2):318–325PubMedCrossRef
21.
Roumelioti ME et al (2010) Abnormal nocturnal heart rate variability response among chronic kidney disease and dialysis patients during wakefulness and sleep. Nephrol Dial Transplant 25(11):3733–3741PubMedCentralPubMedCrossRef
22.
Hayano J et al (1999) Prognostic value of heart rate variability during long-term follow-up in chronic haemodialysis patients with end-stage renal disease. Nephrol Dial Transplant 14(6):1480–1488PubMedCrossRef
23.
Schroeder EB et al (2005) Diabetes, glucose, insulin, and heart rate variability: the atherosclerosis risk in communities (ARIC) study. Diabetes Care 28(3):668–674PubMedCrossRef
24.
Weber TJ et al (2003) Serum FGF23 levels in normal and disordered phosphorus homeostasis. J Bone Miner Res 18(7):1227–1234PubMedCrossRef
25.
Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J, 1996. 17(3): p. 354–81
26.
27.
Sarafidis PA et al (2012) Prevalence, patterns of treatment, and control of hypertension in predialysis patients with chronic kidney disease. Nephron Clin Pract 120(3):c147–c155PubMedCrossRef
28.
Routledge HC, Chowdhary S, Townend JN (2002) Heart rate variability—a therapeutic target? J Clin Pharm Ther 27(2):85–92PubMedCrossRef
29.
Kestenbaum B et al (2005) Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol 16(2):520–528PubMedCrossRef
30.
Nasri H, Baradaran A (2004) Close association between parathyroid hormone and left ventricular function and structure in end-stage renal failure patients under maintenance hemodialysis. Bratisl Lek Listy 105(10–11):368–373PubMed
31.
Polak G et al (2004) Effect of parathormone on heart rate variability in hemodialysis patients. Auton Neurosci 115(1–2):94–98PubMedCrossRef
32.
33.
Gutierrez O et al (2005) Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease. J Am Soc Nephrol 16(7):2205–2215PubMedCrossRef
34.
Wang N et al (2008) Vascular PPARgamma controls circadian variation in blood pressure and heart rate through Bmal1. Cell Metab 8(6):482–491PubMedCrossRef
35.
Gianaros PJ et al (2005) A greater reduction in high-frequency heart rate variability to a psychological stressor is associated with subclinical coronary and aortic calcification in postmenopausal women. Psychosom Med 67(4):553–560PubMedCentralPubMedCrossRef
36.
Longenecker JC et al (2009) Association of low heart rate variability with atherosclerotic cardiovascular disease in hemodialysis patients. Med Princ Pract 18(2):85–92PubMedCrossRef
37.
Saleh FN et al (2003) Parathyroid hormone and left ventricular hypertrophy. Eur Heart J 24(22):2054–2060PubMedCrossRef
38.
39.
Cheung BM, Ong KL, Wong LY (2009) Elevated serum alkaline phosphatase and peripheral arterial disease in the United States National Health and Nutrition Examination Survey 1999–2004. Int J Cardiol 135(2):156–161PubMedCrossRef
40.
Evenepoel P et al (2005) Impact of parathyroidectomy on renal graft function, blood pressure and serum lipids in kidney transplant recipients: a single centre study. Nephrol Dial Transplant 20(8):1714–1720PubMedCrossRef
41.
Naranda J, Ekart R, Pecovnik-Balon B (2011) Total parathyroidectomy with forearm autotransplantation as the treatment of choice for secondary hyperparathyroidism. J Int Med Res 39(3):978–987PubMedCrossRef
42.
Chow KM et al (2003) Improved health-related quality of life and left ventricular hypertrophy among dialysis patients treated with parathyroidectomy. J Nephrol 16(6):878–885PubMed
43.
Takahashi H et al (2014) Impact of parathyroidectomy on serum FGF23 and soluble Klotho in hemodialysis patients with severe secondary hyperparathyroidism. J Clin Endocrinol Metab: p. jc20134050
44.
Sharma J et al (2012) Improved long-term survival of dialysis patients after near-total parathyroidectomy. J Am Coll Surg 214(4):400–407, discussion 407–8PubMedCrossRef
45.
Richards ML et al (2006) Parathyroidectomy in secondary hyperparathyroidism: is there an optimal operative management? Surgery 139(2):174–180PubMedCrossRef
Metadata
Title
Plasma FGF23 levels and heart rate variability in patients with stage 5 CKD
Authors
L.-N. Zhang
G. Yang
C. Cheng
C. Shen
Y.-Y. Cui
J. Zhang
J.-J. Zhang
Z.-X. Shen
M. Zeng
Y.-F. Ge
B. Sun
X.-B. Yu
C. Ouyang
B. Zhang
H.-J. Mao
J. Liu
C.-Y. Xing
X.-M. Zha
N.-N. Wang
Publication date
01-01-2015
Publisher
Springer London
Published in
Osteoporosis International / Issue 1/2015
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-014-2862-7

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