Abstract: Objective To investigate the expression levels of fibroblast growth factor 23 (FGF23), orexin A and bone morphogenetic protein-7 (BMP-7) in patients with renal failure and their relationship with clinical prognosis. 
Methods A total of 65 patients with renal failure were selected as the research group, and 65 healthy people who underwent physical examination during the same period were selected as the control group. The levels of FGF23, orexin A and BMP-7 in the blood of all subjects were detected, compared and analyzed. After 1-year follow-up, the clinical data of patients with different clinical prognoses were compared, and the correlation between FGF23, orexin A, BMP-7 and poor clinical prognosis of renal failure patients was analyzed. COX regression analysis was used to analyze prognostic factors in patients with renal failure, and the receiver operating characteristic curve (ROC) curve of FGF23, orexin A and BMP-7 in predicting poor prognosis in patients with renal failure was analyzed. 
Results Compared with the control group, FGF23 and orexin A expression levels, blood creatinine(CREA), uric acid (UA), blood urea nitrogen (BUN) levels and C-reactive protein (CRP)were higher, while BMP-7 expression levels were lower in the research group (P<0.05). There were 48 cases in the good prognosis group and 17 cases in the poor prognosis group. Compared with the good prognosis group, patients in the poor prognosis group had higher expression levels of CREA, UA, BUN, CRP, FGF23 and orexin A and lower expression levels of BMP-7 (P＜0.05). FGF23 and orexin A were positively correlated with poor clinical prognosis in patients with renal failure, while BMP-7 was negatively correlated with poor clinical prognosis in patients with renal failure (P＜0.05). FGF23 and orexin A were independent risk factors for poor prognosis in patients with renal failure, and BMP-7 was a protective factor (P＜0.05). The AUC of FGF23, orexin A, and BMP-7 was 0.920, 0.697, and 0.849, respectively. 
Conclusion The expression levels of FGF23 and orexin A in patients with renal failure are higher, and the expression level of BMP-7 is lower, which has predictive value for the prognosis of patients with renal failure.

Key words: renal insufficiency, fibroblast growth factor 23, orexins A