Research Article

Correlation between interdialytic weight gain, left ventricular hypertrophy and FGF- 23 in prevalent hemodialysis patients

Sahar Mahmoud Shawky, Maha Mohamed Mohamed Khalifa*, Kholoud Mahmoud Amin and Mohamed Saeed Hassan

Published: 28 July, 2020 | Volume 4 - Issue 2 | Pages: 036-043

Background:Patients with end-stage renal disease are suspected to have significant volume shifts and thereby cardiovascular strain as a result to interdialytic weight gain, chronic fluid overload and fluid removal during dialysis. In long-term hemodialysis patients, higher IDWG (interdialytic weight gain) could be associated with poor survival. Patients with the lowest interdialytic weight gain have the greatest survival. Certain laboratory and imaging modalities could help to assess and monitor the appropriate fluid balance for hemodialysis patients.

FGF -23 might be associated with cardiovascular morbidity in ESRD patients.

Objective: To evaluate correlation between hypervolemia and left ventricular hypertrophy and FGF-23 in hemodialysis patients.

Patients and Methods: This cross sectional study was conducted on 60 prevalent hemodialysis patients. Patients were divided into two groups according to interdialytic weight gain (IDWG): Group I (low IDWG): Patients with absolute weight gain < 3 kg. Group II (high IDWG): patients with weight gain ≥ 3 kg. FGF 23, routine laboratory tests and echocardiography were done for both groups.

Results: high IDWG group has higher systolic blood pressure and LVMI than low IDWG group. In all patients group, FGF-23 had a positive correlation with (weight gain, Na, PO4, PTH, systolic, diastolic blood pressure, LV wall septal and posterior wall thickness and left ventricular mass index) and had a negative correlation with Hb level.

Conclusion: FGF-23 could be a marker of volume overload and LVH in ESRD patients, which affect morbidity and mortality in these patients.

FGF- 23 might be a marker of anemia in ESRD as it has a negative correlation with HB.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001057 Cite this Article Read Full Article PDF


Interdialytic weight gain, End stage renal disease, Fibroblast growth factor 23


  1. Asci G, Marcelli D, Celtik A, Grassmann A, Gunestepe K, et al. Comparison of Turkish and US haemodialysis patient mortality rates: An observational cohort study. Clin. Kidney J. 2016; 9: 476–480. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4886919/
  2. Negishi K, Kobayashi M, Ochiai I, et al. Association between fibroblast growth factor 23 and left ventricular hypertrophy in maintenance hemodialysis patients - Comparison with B-type natriuretic peptide and cardiac troponin T. Circ J. 2010; 74: 2734–2740.
  3. Antlanger M, Hecking M, Haidinger M, Werzowa J, Kovarik JJ, et al. Fluid overload in hemodialysis patients: A cross-sectional study to determine its association with cardiac biomarkers and nutritional status. BMC Nephrol. 2013; 14. PubMed: https://pubmed.ncbi.nlm.nih.gov/24295522/
  4. Kalantar-Zadeh K, Regidor DL, Kovesdy CP, Wyck DV, Bunnapradist S, et al. Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. Circulation. 2009;119 :671–679. PubMed: https://pubmed.ncbi.nlm.nih.gov/19171851/
  5. Lee MJ, Doh FM, Kim CH, Koo HM, Oh HJ, et al. Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients. Am J Nephrol. 2014; 39: 427–435. PubMed: https://pubmed.ncbi.nlm.nih.gov/24819227/
  6. Lullo LD, Gorini A, Russo D, Santoboni A, Ronco C. Left Ventricular Hypertrophy in Chronic Kidney Disease Patients: From Pathophysiology to Treatment. Cardio Renal Med. 2015; 5: 254–266. PubMed: https://pubmed.ncbi.nlm.nih.gov/26648942/
  7. Unver S, Kavlak E, Gümüsel HK, Celikbilek F, Esertas K, et al. Correlation between hypervolemia, left ventricular hypertrophy and fibroblast growth factor 23 in hemodialysis patients. Ren. Fail. 2015; 37: 951–956. PubMed: https://pubmed.ncbi.nlm.nih.gov/26030798/
  8. Ghonemy TA, Farag SE, Soliman SA, El-okely A, El-hendy Y, et al. Epidemiology and risk factors of chronic kidney disease in the El-Sharkia Governorate, Egypt. Saudi J Kidney Dis Transpl. 2016; 27: 111–117. PubMed: https://pubmed.ncbi.nlm.nih.gov/26787576/
  9. Kahraman A, Akdam H, Alp A, et al. Impact of interdialytic weight gain (IDWG) on nutritional parameters, cardiovascular risk factors and quality of life in hemodialysis patients. Bantao J. 2015; 13: 25–33.
  10. Rebholz CM, Grams ME, Coresh J, Selvin E, Inker LA, et al. Serum Fibroblast Growth Factor - 23 Is Associated with Incident Kidney Disease. J Am Soc Nephrol. 26: 192–200. PubMed: https://pubmed.ncbi.nlm.nih.gov/25060052
  11. Afifi A, Karim MA. Renal replacement therapy in Egypt: First annual report of the Egyptian Society of Nephrology, 1996. East. Mediterr Heal J. 1999; 5: 1023–1029.
  12. Mominadam S, Özkahya M, Kayikcioglu M, Toz H, Asci G, et al. Interdialytic blood pressure obtained by ambulatory blood pressure measurement and left ventricular structure in hypertensive hemodialysis patients. Hemodial. Int. 2008; 12: 322–327. PubMed: https://pubmed.ncbi.nlm.nih.gov/18638087/
  13. Cabrera C, Brunelli SM, Rosenbaum D, Anum E, Ramakrishnan K, et al. A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients. BMC Nephrol. 2015; 16. PubMed: https://pubmed.ncbi.nlm.nih.gov/26197758
  14. Brown M, Burrows L, Pruett T, Burrows T. Hemodialysis-induced myocardial Stunning. Nephrol Nurs J. 2015; 42: 59-66. PubMed: https://pubmed.ncbi.nlm.nih.gov/26290919/
  15. Humalda JK, Riphagen IJ, Assa S, Hummel YM, Westerhuis R, et al. Fibroblast growth factor 23 correlates with volume status in haemodialysis patients and is not reduced by haemodialysis. Nephrol Dial Transplant. 2016; 31: 1494–1501. PubMed: https://pubmed.ncbi.nlm.nih.gov/26602863
  16. Minoo F, Alamdari A, Karimi H. Does fibroblast growth factor 23 correlates with volume status in hemodialysis patients? J Nephropathol. 2019; 8.
  17. Li JX, Yu GQ, Zhuang YZ. Impact of serum FGF23 levels on blood pressure of patients with chronic kidney disease. Eur Rev Med. Pharmacol Sci. 2018; 22: 721–725. PubMed: https://pubmed.ncbi.nlm.nih.gov/29461601/
  18. Unsal A, Budak SK, Koc Y, Basturk T, Sakaci T, et al. Relationship of fibroblast growth factor 23 with left ventricle mass index and coronary calcificaton in chronic renal disease. Kidney Blood Press Res. 2012; 36: 55–64. PubMed: https://pubmed.ncbi.nlm.nih.gov/22854270/
  19. Carpenter TO, Insogna KL, Zhang JH, et al. Circulating levels of soluble klotho and FGF23 in X-linked hypophosphatemia: Circadian variance, effects of treatment, and relationship to parathyroid status. J Clin Endocrinol Metab. 2010; 95.
  20. Wesseling-Perry K, Pereira RC, Wang H, Elashoff RM, Sahney S, et al. Relationship between plasma fibroblast growth factor-23 concentration and bone mineralization in children with renal failure on peritoneal dialysis. J Clin Endocrinol Metab. 2009; 94: 511–517. PubMed: https://pubmed.ncbi.nlm.nih.gov/19050056/
  21. Kojima F, Uchida K, Ogawa T, Tanaka Y, Nitta K. Plasma levels of fibroblast growth factor-23 and mineral metabolism in diabetic and non-diabetic patients on chronic hemodialysis. Int Urol Nephrol. 2008; 40: 1067–1074. PubMed: https://pubmed.ncbi.nlm.nih.gov/18791804/
  22. Sliem H, Tawfik G, Moustafa F, Zaki H. Relationship of associated secondary hyperparathyroidism to serum fibroblast growth factor-23 in end stage renal disease: A case-control study. Indian J Endocrinol Metab. 2011; 15: 105. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124995/


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