Aref H, Ezzat H and Elsayed W
Background: Malnutrition is a prevalent complication in patients on maintenance hemodialysis and is considered a major risk factor for mortality in those patients. FGF23 has also been associated with mortality in dialysis patients. Little is known about the association between FGF23 and malnutrition in such patients. Aim of the study: The aim of this study was to investigate possible relationship between FGF23 and malnutrition in maintenance hemodialysis patients. 85 patients on maintenance hemodialysis were studied. In addition to routine laboratory parameters, serum intact fibroblast growth factor-23 levels were done, and anthropometric measures were done after reaching dry weight which included MAC, WC and WHR. BMI was calculated for all patients. SGADMS (Subjective Global Assessment -Dialysis Malnutrition Score) was calculated based on medical history and clinical examination. Results: The mean BMI was 20.2 ± 3 kg/m2. The mean hemoglobin level was 9.7 ± 2 g/dl. The mean serum calcium level was 7.6 ± 1 mg/dl. The mean serum albumin was 3.9 ± 1 g/dl. The mean mid-arm circumference was 22.9 ± 2 cm. The mean waist circumference was 90.5 ± 11 cm. The mean malnutrition score was 28.2 ± 3 points. FGF23 levels ranged from 13.5 to 675 ng/L, and accordingly patients were divided into four quartiles. Patients in the lowest FGF23 quartile showed the shortest dialysis vintage, lowest serum calcium, phosphorus, creatinine, albumin, total proteins, MAC, and the highest iPTH level. The highest malnutrition score was associated with the lowest FGF23 quartile. There was highly significant positive correlation between FGF23 level and each of BMI, WHR (p=0.006 and 0.001 respectively) and a highly significant negative correlation with malnutrition score (p=0.000). Conclusion: Low FGF23 levels may be associated with malnutrition in maintenance hemodialysis patients. FGF23 used in conjunction with other objective nutritional assessment tools may be of value in determining nutritional status of hemodialysis patients.