Hemodiyaliz Hastalarında Serum FGF-23 ve Sklerostin Düzeyleri: Kemik Mineral Dansitesi ve Kırık Riski ile İlişkisi

Abstract

Amaç: Bu çalışmada hemodiyaliz hastalarında serum fibroblast büyüme faktörü-23 (FGF-23) ve sklerostin düzeylerinin sağlıklı kontroller ile karşılaştırılması ve bu biyobelirteçlerin kemik mineral dansitesi (KMD) ve kırık riski ile ilişkilerinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya 40 hemodiyaliz hastası ve yaş-cinsiyet açısından eşleştirilmiş 26 sağlıklı kontrol olmak üzere toplam 66 birey dahil edildi. Demografik, klinik ve biyokimyasal veriler kaydedildi. Serum FGF-23 ve sklerostin düzeyleri ELISA yöntemiyle ölçüldü. KMD, lomber omurga ve femur boynunda DXA ile değerlendirildi; kırık riski FRAX skorlarıyla hesaplandı. Korelasyon ve çok değişkenli regresyon analizlerine ek olarak, gruplar arası karşılaştırmalar uygun istatistiksel testlerle yapıldı ve kategorik değişkenler ki-kare analizi ile değerlendirildi. Bulgular: Hemodiyaliz hastalarında serum FGF-23 (p<0,001) ve sklerostin (p<0,001) düzeyleri kontrollerden anlamlı derecede yüksekti. Lomber omurga ve femur KMD değerleri hemodiyaliz grubunda daha düşüktü (sırasıyla p=0,004 ve p=0,006). FRAX majör osteoporotik kırık (p=0,002) ve kalça kırığı risk skorları (p=0,001) ise anlamlı olarak daha yüksekti. FGF-23 ve sklerostin, serum fosfat (p=0,002 ve p=0,004) ve PTH (p=0,01 ve p=0,009) ile pozitif; lomber KMD ile negatif (p=0,01 ve p=0,008) korelasyon gösterdi. Çok değişkenli regresyon analizlerinde fosfat (p=0,01) ve PTH (p=0,008), FGF-23 için; fosfat (p=0,02) ve lomber KMD (p=0,01) ise sklerostin için bağımsız belirleyiciler olarak bulundu. Sonuç: Hemodiyaliz hastalarında artmış FGF-23 ve sklerostin düzeyleri, azalmış KMD ve artmış kırık riski ile karakterizedir. Bu biyobelirteçler, kronik böbrek hastalığında kemik kırılganlığının değerlendirilmesinde densitometrik ölçümlere ek katkı sağlayabilir.

Keywords

• Kronik böbrek hastalığı
• hemodiyaliz
• sklerostin
• kemik mineral dansitesi

Serum FGF-23 and Sclerostin Levels in Hemodialysis Patients: Associations with Bone Mineral Density and Fracture Risk

Abstract

Aim: This study aimed to evaluate serum fibroblast growth factor-23 (FGF-23) and sclerostin levels in hemodialysis patients compared with healthy controls, and to investigate their associations with bone mineral density (BMD) and fracture risk.. Material and methods: A total of 66 participants were included: 40 patients undergoing maintenance hemodialysis and 26 age- and sex-matched healthy controls. Demographic, clinical, and biochemical parameters were recorded. Serum FGF-23 and sclerostin were measured using ELISA. BMD was assessed at the lumbar spine and femoral neck using DXA, and fracture risk was estimated using FRAX scores. In addition to correlation and multivariate regression analyses, between-group comparisons were performed using appropriate statistical tests, and categorical variables were evaluated with chi-square analysis. Results: Hemodialysis patients had significantly higher serum FGF-23 (p<0.001) and sclerostin (p<0.001) levels compared with controls. Lumbar spine and femoral BMD values were significantly lower in the hemodialysis group (p=0.004 and p=0.006, respectively), while FRAX major osteoporotic and hip fracture risk scores were significantly higher (p=0.002 and p=0.001, respectively). FGF-23 and sclerostin showed positive correlations with phosphate (p=0.002 and p=0.004) and PTH (p=0.01 and p=0.009), and negative correlations with lumbar BMD (p=0.01 and p=0.008). In multivariate regression, phosphate (p=0.01) and PTH (p=0.008) were independent determinants of FGF-23, while phosphate (p=0.02) and lumbar BMD (p=0.01) were independent determinants of sclerostin. Conclusion: Elevated FGF-23 and sclerostin levels, along with reduced BMD and increased fracture risk, characterize hemodialysis patients. These biomarkers may complement densitometric measures in evaluating bone fragility in chronic kidney disease.

Keywords

• Chronic kidney disease
• hemodialysis
• sclerostin
• bone mineral density

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