Objective. Evaluation of the participation of fibroblast growth factor 23 (FGF-23) in relation to mineral metabolism indicators in the development of acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) receiving renal replacement therapy; assessment of the risk of fatal and non-fatal cases .
Material and methods. A prospective cohort study of 85 patients with stage 5D CKD on program hemodialysis was conducted over a period of 3 years. At the first stage of the study, indicators characterizing mineral and bone disorders such as blood phosphate, calcium, parathyroid hormone (PTH), calcitriol (1,25(OH)D), fibroblast growth factor 23 (FGF-23) and transmembrane protein Alpha-Clotho (A-Klotho) levels were determined. The second stage of the study was carried out 3.1±0.1 years after with the registration of cases of fatal and non-fatal AMI.
Results. 10 cases of AMI were registered: 6 non-fatal and 4 fatal cases. It was found that high FGF-23 and low A-Klotho levels do not have independent risk activity against AMI (P>0.05). Analysis of the combined effect of high FGF-23 and/or low A-Klotho levels with hyperphosphatemia and 1,25(OH)D3 deficiency demonstrates a significantly significant increase in the risk of developing all cases of AMI (P<0.05); a relationship with 1,25(OH)D3 deficiency in cases of fatal and non-fatal AMI (P<0.05) was shown. A statistically significant effect of an isolated 1,25(OH)D3 deficiency, a concomitant effect of several factors (hyperphosphatemia, hyperparathyroidism, vitamin D deficiency) on the risk of AMI was established.
Conclusion. FGF-23 is one of the key markers for the development of both fatal and non-fatal cases of AMI, predicting cardiovascular risk in CKD patients. Data on the concomitant influence of several factors among mineral-bone disorders on the risk of AMI are noteworthy.

Keywords: 25(OH)D3, fibroblast growth factor 23, hyperphosphatemia, hyperparathyroidism, acute myocardial infarction