Document Type : Original Article
Authors
1
Department of Internal Medicine, Faculty of Medicine, Minia University, Egypt.
2
Department of Internal Medicine, Faculty of Medicine, Minia University, Egypt
3
department of Clinical Pathology Faculty of Medicine, Minia University, Egypt.
Abstract
Background: Anemia is commonly observed in the course of chronic kidney disease (CKD) and it is
associated with diminishing the quality of a patient’s life. It also increases morbidity and mortality
and CKD progression rate, so it is critical to continue investigations that help explain risk factors
involved in the development of anemia in CKD. FGF23 is a promising biomarker of adverse
outcomes in patients with CKD. Several studies have suggested a possible association between
FGF23 and anemia in these patients. The aim of the current study was to detect level of FGF23 in
CKD patients and clarify the relation between of FGF23 level and anemia in CKD patients. Subjects
and Methods: Subjects: This case - control study was conducted on 90 subjects at the nephrology
department of Minia University Hospital through the period from March 2019 to November 2019
selected and divided into three groups containing both control and patients groups. Group І included
30 patients with chronic kidney disease, not on hemodialysis, Group ІI included 30 patients with
chronic kidney disease on Hemodialysis and both are with anemia. Group ІII included 30 individuals
who are the healthy group. Exclusion criteria: Pregnancy, liver cirrhosis, Polycystic kidney disease,
Renal cancer, Recent chemotherapy or immunosuppressive therapy, New York Heart Association
class 3 or 4 heart failure, Multiple myeloma, Overt gastrointestinal diseases such as untreated gastric
cancer and ulcers, Abnormalities of the white blood cell count and differential or platelet count.
Laboratory methods: A)Blood sampling protocol: 6 ml of blood was withdrawn by sterile
venipuncture and before dialysis session in the second group, left to be clotted then centrifuged and
the separated serum was divided into liquates. One was designated for the immediate assessment of
routine chemistry, The rest of serum was stored at -5 c for subsequent assay of specific labs. B)
Routine laboratory Investigations: Using the commercially available kits, all patients underwent
full laboratory investigation including Complete blood count (CBC) and Renal function tests (serum
urea and creatinine). C) Specific investigation: eGFR, HS-CRP, Iron profile (serum Iron, Ferritin,
TIBC), calcium (Ca), phosphate (P), intact (i)-PTH level and i-FGF23 level. D) Imaging studies:
Abdominal ultrasound was performed by General Electric ultrasound and transducer with a frequency
of 3.5 megahertz (MHz), USA. Statistical analysis: Statistical analysis was conducted using the
Statistical Package for Social Sciences (SPSS software version 25). Results: Elevated FGF23
inversely correlated with iron deficiency anemia in patients with CKD dialysis patients of statistical
significance (P=0.012). Conclusion: FGF23 levels in CKD are higher than levels observed in healthy
patients, elevated FGF23 inversely correlated with iron deficiency anemia in patients with CKD
patients, and with high sensitivity and specificity of FGF23 as a promising marker for prediction of
disease progression.
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