Abstract: Objective  Vascular calcification is closely related to cardiovascular disease in patients with peritoneal dialysis (PD). Fibroblast growth factor 21 (FGF21) as an endocrine hormone has a protective effect on cardiovascular function. This study explored the correlation between serum FGF21 and vascular calcification in different parts of vessels in PD patients.  Methods  PD patients who were evaluated for adequacy of PD in the Department of Nephrology, The First Affiliated Hospital of Soochow University from August 2021 to October 2022 were included in this study. Healthy people who underwent physical examination during the same period were recruited as the controls. Fasting blood serum was collected from all subjects, and serum FGF21 and FGF23 levels were determined by enzyme-linked immunoassay. Chest and abdomen CT were conducted in PD patients and processed by the GE workstation. Volume of coronary artery calcification (CAC) and abdominal aortic calcification (AAC) was quantitatively assessed. PD patients were grouped according to the presence of CAC or AAC. Multivariate logistic regression was used to analyze the relationship between serum FGF21 level and the presence of CAC or AAC.  Results  A total of 136 PD patients and 20 healthy controls were included in this study. Serum FGF21 in PD patients was significantly higher than that in normal subjects [383.0 (110.3～767.9) vs. 13.3 (5.5～129.1) pg/mL, Z=5.087, P＜0.001]. With the increase of age (r=0.247, P=0.004) and dialysis vintage (r=0.306, P＜0.001), serum FGF21 in PD patients was gradually increased. FGF21 was positively correlated with CAC volume (r=0.254, P=0.005) and AAC volume (r=0.354, P＜0.001). Furthermore, there were different risk factors for CAC and AAC. The increase of FGF21 was independently associated with the increased risk of AAC (OR=1.783, 95% CI: 1.251～2.541, P=0.001) rather than CAC in PD patients.  Conclusions  Serum FGF21 in PD patients is significantly higher than that in healthy people. The increase of FGF21 is associated with an increased risk of AAC. Therefore, FGF21 may serve as a biomarker and potential therapeutic target for vascular calcification.

Key words:  Peritoneal dialysis, Vascular calcification, Fibroblast growth factor 21