Association between circulating fibroblast growth factor 21 and mortality in end-stage renal disease.

Fibroblast growth factor 21 (FGF21) is an endocrine factor that regulates glucose and lipid metabolism. Circulating FGF21 predicts cardiovascular events and mortality in type 2 diabetes mellitus, including early-stage chronic kidney disease, but its impact on clinical outcomes in end-stage renal disease (ESRD) patients remains unclear. This study enrolled 90 ESRD patients receiving chronic hemodialysis who were categorized into low- and high-FGF21 groups by the median value. We investigated the association between circulating FGF21 levels and the cardiovascular event and mortality during a median follow-up period of 64 months. A Kaplan-Meier analysis showed that the mortality rate was significantly higher in the high-FGF21 group than in the low-FGF21 group (28.3% vs. 9.1%, log-rank, P = 0.034), while the rate of cardiovascular events did not significantly differ between the two groups (30.4% vs. 22.7%, log-rank, P = 0.312). In multivariable Cox models adjusted a high FGF21 level was an independent predictor of all-cause mortality (hazard ratio: 3.98; 95% confidence interval: 1.39-14.27, P = 0.009). Higher circulating FGF21 levels were associated with a high mortality rate, but not cardiovascular events in patient with ESRD, suggesting that circulating FGF21 levels serve as a predictive marker for mortality in these subjects

Univariate Cox regression analyses of all-cause mortality.

<p>Univariate Cox regression analyses of all-cause mortality.</p

Correlations coefficients of circulating FGF21 levels for associated clinical factors.

<p>Correlations coefficients of circulating FGF21 levels for associated clinical factors.</p

Association between circulating FGF21 and outcomes.

<p>The Kaplan-Meier analysis showed that the mortality rate was significantly higher in the high-FGF21 group than in the low-FGF21 group (log-rank, <i>P</i> = 0.034) (A), while the cardiovascular event-free survival rate did not significantly differ between the two groups (log-rank, <i>P</i> = 0.312) (B).</p

Distribution of circulating FGF21 levels in this study.

<p>FGF21 was detectable in the serum of all 90 patients, with serum concentrations ranging from 164 to 13214 pg/mL (median: 1981, interquartile range: 1034–2995 pg/mL).</p

Baseline characteristics of patients according to study group.

<p>Baseline characteristics of patients according to study group.</p