〔Abstract〕 Objective To explore the correlation between serum fibroblast growth factor-23(FGF23) concentration and heart failure and all-cause death in patients with end-stage renal disease(ESRD).Methods The prospective cohort study design was used in the present study. The ESRD patients who were admitted to the department of nephropathy in the Hospital and without heart failure symptoms were recruited in this study. The data of patients was collected through baseline questionnaires, physical examinations, echocardiography, and laboratory examinations.The serum FGF23 levels were measured by enzyme-linked immunosorbent assay(ELISA). The follow-up time was2 years. The onset of heart failure(ACC/AHA stage C-D) and all-cause death were composite endpoint events.The Cox proportional risk model was used to explore the risk factors of outcome events. Through subgroup analyses and interaction analyses, further exploration was conducted to determine whether there was heterogeneity in the association between FGF23 and outcome events in different subgroups.Results Ultimately, 107 ESRD patients were included in this study, with an average age of(52. 00 ± 12. 51) years. There were 39 males(36. 45%), and the median follow-up time was 23 months(21, 25 months). There were 32(29. 9%) outcome events, of which 22(20. 6%) onset of heart failure and 10(9. 3%) all-cause of deaths. The results of this study showed that the concentration of FGF23 in the outcome event group was significantly higher than that in the non-event group [(4. 40 ±1. 16) pmol/mlvs(3. 85 ± 0. 82) pmol/ml,P<0. 05]. The Cox proportional risk model showed that the elevated FGF23 was associated with increased risk of the composite endpoint events in ESRD patients(HR= 1. 730, 95%CI: 1. 164-2. 570,P= 0. 007). Subgroup analyses showed that there was an interactive effect between FGF23levels and gender on the risk of cardiovascular outcome events. Especially in male ESRD patients, the increased FGF23 level was correlated with a higher risk of cardiovascular events(P-interaction<0. 05).Conclusion Elevated serum FGF23 is an independent risk factor for the onset of heart failure and all-cause of mortality in ESRD patients,especially in male patients.