Diabetes mellitus modifies the association between chronic kidney disease–mineral and bone disorder biomarkers and aortic stiffness in peritoneal dialysis patients

Abstract

Abstract This study aimed to investigate the relationship of four chronic kidney disease–mineral and bone disorder (CKD–MBD) biomarkers, including intact parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), soluble klotho, and fetuin-A, with aortic stiffness in peritoneal dialysis (PD) patients, comparing those with and without diabetes mellitus (DM). A total of 213 patients (mean age 58 ± 14 years; 81 (38.0%) patients with DM) were enrolled. Their aortic pulse wave velocity (PWV) was measured using pressure applanation tonometry, while serum intact PTH, FGF23, α-klotho, and fetuin-A levels were measured using enzyme-linked immunosorbent assay. Overall, patients with DM had higher aortic PWV than those without (9.9 ± 1.8 versus 8.6 ± 1.4 m/s, p < 0.001). Among the four CKD–MBD biomarkers, FGF23 levels were significantly lower in DM group (462 [127–1790] versus 1237 [251–3120] pg/mL, p = 0.028) and log-FGF23 independently predicted aortic PWV in DM group (β: 0.61, 95% confidence interval: 0.06–1.16, p = 0.029 in DM group; β: 0.10, 95% confidence interval: −0.24–0.45, p = 0.546 in nonDM group; interaction p = 0.016). In conclusion, the association between FGF23 and aortic PWV was significantly modified by DM status in PD patients.