FGF-23 and Cognitive Function in Hemodialysis Patients.
cognitive impairment is common in hemodialysis (HD) patients, the etiology of and risk
factors for its development remain unclear. Fibroblast growth factor 23 (FGF-23) levels
are elevated in HD patients and are associated with multiple adverse outcomes including
increased mortality and left ventricular hypertrophy. Despite FGF receptors being
present throughout the brain, t... read morehere are no prior studies which have assessed whether
FGF-23 levels are associated with cognitive performance. We measured FGF-23 levels in
263 prevalent hemodialysis patients in whom comprehensive neuro-cognitive testing was
also performed. The cross-sectional association between patient characteristics and
FGF-23 levels were assessed using multivariable linear regression. Principal factor
analysis was used to derive two factors from cognitive test scores, representing memory
and executive function, which by definition carried a mean of zero and standard
deviation of one. Multivariable linear regression adjusting for age, sex, education
status as well as other relevant covariates was used to explore the relationship between
FGF-23 and each measure of cognitive function. The mean age of participants was 63
years, 46% were women and 22% were African American. The median FGF-23 level was 3098
RU/ml (25th-75th percentile, 1139-7960 RU/ml). Younger age, lower prevalence of
diabetes, longer dialysis vintage and higher levels of calcium and phosphorus were
independently associated with higher FGF-23 levels. Higher FGF-23 was independently
associated with a lower composite memory score [per doubling of FGF-23, beta = -0.08 SD
(95% CI -0.16, -0.01)] and highest quartile versus lowest quartile, [beta = -0.42 SD
(-0.82, -0.02)]. There was no definite association of FGF 23 with executive function
when examined as a continuous variable [beta=-0.03 SD (-0.10, 0.04)], however there was
a trend in the quartile analysis [beta=-0.28 SD (-0.63, 0.07), p=0.11, for 4th quartile
versus 1st quartile]. FGF-23 was independently associated with worse performance on a
composite memory score, even after adjustment for potential confounders, including
measures of mineral metabolism. High FGF-23 levels in hemodialysis patients may
contribute to cognitive impairment within this
Thesis (M.S.)--Tufts University, 2013.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Mark Sarnak.
Committee: Daniel Weiner, and Hocine Tighiouart.
Keywords: Health sciences, and Neurosciences.read less