Association between fibroblast growth factor 23 and mortality in South African chronic kidney disease patients on chronic dialysis

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dc.contributor.authorWaziri, Bala
dc.date.accessioned2020-10-01T08:38:00Z
dc.date.available2020-10-01T08:38:00Z
dc.date.issued2019
dc.descriptionA research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Epidemiology and Biostatistics October 2019en_ZA
dc.description.abstractBackground: Few studies have linked high levels of plasma C-terminal fibroblast growth factor 23 (FGF23) with poor clinical outcomes in patients on maintenance haemodialysis (MHD), while the association between intact FGF23 and mortality in this group of patients remains inconclusive. Therefore, the aim of this study was to evaluate the association between plasma levels of intact FGF23 and mortality in dialysis patients. Methods: A prospective multicenter study involving 165 patients undergoing dialysis at three dialysis centres in Johannesburg was undertaken between 1st October 2014 and 31st December 2017. The association between the quartiles of FGF23 and mortality was assessed using the Cox proportional hazard model. Results: The study comprised 165 chronic dialysis patients (111 blacks, 54 whites) with a mean age of 46.6 ±14.2 years. During a three year follow up period, there were 46 deaths (1.03 per 100 person-years). The median plasma FGF23 level was 382 pg/ml (interquartile range [IQR], 145-2977). In adjusted multivariable analyses, there was a non-statistically significant increase in the risk of mortality with higher quartiles of FGF23 levels: the adjusted hazard ratios (HR) for the second, third and fourth quartiles were HR 3.20 (95% CI, 0.99-10.35; P=0.052), HR 2.43(95 % CI,0.65-9.09; P=0.19), and HR 2.09 (95% CI, 0.66-7.32; P= 0.25),respectively. Corrected serum calcium 2.38-2.5 mmol/l [HR 2.98 (95% CI, 1.07-8.29; P=0.04] and > 2.50 mmol/l [HR 5.50 (95% CI, 1.84-16.48; P=0.002] were independently associated with increased risk of death. Likewise, patients with intact parathyroid hormone > 600 pg/ml had a 3.46-fold higher risk of death (HR 3.46, 95% CI, 1.22-9.82 P=0.019). These findings persisted in time -dependent analyses. Conclusion: Higher levels of intact FGF23 appear not to be independently associated with all-cause mortality in our dialysis patients, while hypercalcaemia and severe hyperparathyroidism were found to be independent predictors of mortality in this cohort of patients.en_ZA
dc.description.librarianMT 2020en_ZA
dc.facultyFaculty of Health Sciencesen_ZA
dc.identifier.urihttps://hdl.handle.net/10539/29750
dc.language.isoenen_ZA
dc.titleAssociation between fibroblast growth factor 23 and mortality in South African chronic kidney disease patients on chronic dialysisen_ZA
dc.typeThesisen_ZA
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