FGF23 in hemodialysis patients is associated with left ventricular hypertrophy and reduced ejection fraction

Background: Fibroblast growth factor 23 (FGF23) is known to cause left ventricular hypertrophy (LVH), but controversy exists concerning its effect in dialysis. This study evaluated associations between FGF23 levels, echocardiography and prognosis in patients on hemodialysis (HD). Methods: Patients >18 years on chronic HD were included in this cross-sectional study. Plasma C-terminal FGF23 concentration was measured with ELISA and transthoracic echocardiography was performed, both before and after HD treatment. Results: 239 haemodialysis (HD) patients were included in the study. The FGF23 was median 3560 RU/ml (IQR 1447–9952). The mean left ventricular mass index (LVMI) was 110.2 ± 26.7 g/m2 and the left ventricular ejection fraction (LVEF) was 52.7 ± 9.9%. Defined by LVMI, LVH was found in 110 patients (46%), of which 92 (84%) had hypertension (p  18 años con HD crónica en este estudio transversal. La concentración del FGF23 en el extremo C del plasma se midió con ELISA y se realizó una ecocardiografía transtorácica, antes y después del tratamiento de HD. Resultados: Se incluyeron 239 pacientes en HD en el estudio. El FGF23 tenía una mediana de 3.560 RU/ml (amplitud intercuartílica: 1.447-9.952). El índice de masa ventricular izquierdo (IMVI) medio fue de 110,2 ± 26,7 g/m2 y la fracción de eyección del ventrículo izquierdo (FEVI) fue del 52,7 ± 9,9%. Definida por el IMVI, la HVI se localizó en 110 pacientes (46%), de los cuales 92 (84%) presentaban hipertensión (p < 0,01). Los pacientes con HVI presentaron niveles del FGF23 de 5.319 RU/ml (amplitud intercuartílica: 1.858-12.859) y aquellos sin 2.496 RU/ml (amplitud intercuartílica: 1.141-7.028) (p < 0,01). El FGF23 fue considerablemente positivo correlacionado con el IMVI (p < 0,01) y negativo con la FEVI (p < 0,01). En un análisis multivariante, el FGF23 se correlacionó con la FEVI (p < 0,01), pero solo marginalmente con el IMVI (p < 0,01). Los episodios cardiovasculares en el período de seguimiento no se correlacionaron con el FGF23. Además, el FGF23 se correlacionó independientemente con la mortalidad general (p < 0,001). Conclusión: El FGF23 se correlacionó positivamente con la HVI y negativamente con la FEVI. El FGF23 fue un factor independiente para la mortalidad general. Keywords: Fibroblast growth factor 23, Left ventricular hypertrophy, Left ventricular ejection fraction, Dialysis, End-stage renal disease, Echocardiography, Phosphate, Parathyroid hormone, Palabras clave: Factor de crecimiento fibroblástico 23, Hipertrofia ventricular izquierda, Fracción de eyección ventricular izquierda, Diálisis, Enfermedad renal terminal, Ecocardiografía, Fosfato, Hormona paratiroide

The formation and design of the TRIAGE study--baseline data on 6005 consecutive patients admitted to hospital from the emergency department

BACKGROUND: Patient crowding in emergency departments (ED) is a common challenge and associated with worsened outcome for the patients. Previous studies on biomarkers in the ED setting has focused on identification of high risk patients, and and the ability to use biomarkers to identify low-risk patients has only been sparsely examined. The broader aims of the TRIAGE study are to develop methods to identify low-risk patients appropriate for early ED discharge by combining information from a wide range of new inflammatory biomarkers and vital signs, the present baseline article aims to describe the formation of the TRIAGE database and characteristize the included patients. METHODS: We included consecutive patients ≥ 17 years admitted to hospital after triage staging in the ED. Blood samples for a biobank were collected and plasma stored in a freezer (−80 °C). Triage was done by a trained nurse using the Danish Emergency Proces Triage (DEPT) which categorizes patients as green (not urgent), yellow (urgent), orange (emergent) or red (rescusitation). Presenting complaints, admission diagnoses, comorbidities, length of stay, and ‘events’ during admission (any of 20 predefined definitive treatments that necessitates in-hospital care), vital signs and routine laboratory tests taken in the ED were aslo included in the database. RESULTS: Between September 5(th) 2013 and December 6(th) 2013, 6005 patients were included in the database and the biobank (94.1 % of all admissions). Of these, 1978 (32.9 %) were categorized as green, 2386 (39.7 %) yellow, 1616 (26.9 %) orange and 25 (0.4 %) red. Median age was 62 years (IQR 46–76), 49.8 % were male and median length of stay was 1 day (IQR 0–4). No events were found in 2658 (44.2 %) and 158 (2.6 %) were admitted to intensive or intermediate-intensive care unit and 219 (3.6 %) died within 30 days. A higher triage acuity level was associated with numerous events, including acute surgery, endovascular intervention, i.v. treatment, cardiac arrest, stroke, admission to intensive care, hospital transfer, and mortality within 30 days (p < 0.001). CONCLUSION: The TRIAGE database has been completed and includes data and blood samples from 6005 unselected consecutive hospitalized patients. More than 40 % experienced no events and were therefore potentially unnecessary hospital admissions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13049-015-0184-1) contains supplementary material, which is available to authorized users