Subscribe to RSS
DOI: 10.1055/a-2168-5089
The Relationship Between Serum Fibroblast Growth Factor 23 and Klotho Protein and Low Bone Mineral Density in Middle-Aged and Elderly Patients with End-Stage Renal Disease
Funding Information Scientific Research Foundation of Hebei Provincial Health Commission – 20231481 The project of introducing overseas students of Hebei province – C20210357 Clinical Medical Talents Training Project funded by Hebei Provincial Department of Finance and Hebei Provincial Health and Construction Commission- ZF2023235
Abstract
To assess the correlation between serum fibroblast growth factor 23 (FGF-23)/Klotho levels and end-stage renal disease (ESRD) in middle-aged and elderly patients combined with low bone mineral density (BMD). The BMD of the lumbar vertebrae and femoral neck of 87 patients with ESRD was measured using a dual-energy X-ray bone densitometer during hospitalisation and the patients were divided into a normal bone mass group and a low bone mass group. Haemoglobin, albumin, urea nitrogen, uric acid, creatinine, low-density lipoprotein cholesterol, alkaline phosphatase, blood calcium, blood phosphorus and full parathyroid hormone were detected using an automatic biochemical analyser. The levels of serum FGF-23, Klotho and activated vitamin D in the patients with ESRD were measured via an enzyme-linked immunosorbent assay. Older age and decreased serum creatinine levels and serum Klotho levels were associated with low bone mass. There were significantly more men in normal bone mass group (n=49, 74.24%) than in low bone mass group (n=8, 38.10%). The correlation analysis showed that BMD was negatively correlated with age but positively correlated with serum Klotho. The binary logistic regression analysis indicated that old age and the decrease in serum Klotho level were independent risk factors of a low BMD (all p<0.05). In conclusion, serum Klotho is closely related to BMD changes in middle-aged and elderly patients with ESRD. A high Klotho level is a protective factor and is expected to be a marker in reducing bone mineral metabolism disorders and improving the prognosis of patients with ESRD.
Key words
end-stage renal disease - fibroblast growth factor 23 - Klotho protein - bone mineral density - chronic kidney disease-mineral - middle-aged and elderlyPublication History
Received: 18 June 2023
Accepted after revision: 30 August 2023
Article published online:
24 October 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Ikizler TA, Burrowes JD, Byham-Gray LD. et al. KDOQI clinical practice guideline for nutrition in CKD: 2020 Update. Am J Kidney Dis 2020; 76: S1-S107
- 2 Thurlow JS, Joshi M, Yan G. et al. Global epidemiology of end-stage kidney disease and disparities in kidney replacement therapy. Am J Nephrol 2021; 52: 98-107
- 3 Cannata-Andía JB, Martín-Carro B, Martín-Vírgala J. et al. Chronic kidney disease-mineral and bone disorders: pathogenesis and management. Calcif Tissue Int 2021; 108: 410-422
- 4 Pazianas M, Miller PD. Osteoporosis and chronic kidney disease-mineral and bone disorder (CKD-MBD): back to basics. Am J Kidney Dis 2021; 78: 582-589
- 5 Lu X, Hu MC. Klotho/FGF23 Axis in chronic kidney disease and cardiovascular disease. Kidney Dis (Basel) 2017; 3: 15-23
- 6 Agrawal A, Ni P, Agoro R. et al. Identification of a second Klotho interaction site in the C terminus of FGF23. Cell Rep 2021; 34: 108665
- 7 Yanucil C, Kentrup D, Campos I. et al. Soluble α-klotho and heparin modulate the pathologic cardiac actions of fibroblast growth factor 23 in chronic kidney disease. Kidney Int 2022; 102: 261-279
- 8 Richter B, Faul C. FGF23 actions on target tissues – with and without klotho. Front Endocrinol (Lausanne) 2018; 9: 189
- 9 Singh S, Grabner A, Yanucil C. et al. Fibroblast growth factor 23 directly targets hepatocytes to promote inflammation in chronic kidney disease. Kidney Int 2016; 90: 985-996
- 10 Chen H, Li J, Zhang D. et al. Role of the fibroblast growth factor 19 in the skeletal system. Life Sci 2021; 265: 118804
- 11 Kuro-O M. The Klotho proteins in health and disease. Nat Rev Nephrol 2019; 15: 27-44
- 12 Zhou Y, Liu S, Wang X. et al. Implications of gender-based variabilities in bone mineral density and hemoglobin levels. BMC Musculoskelet Disord 2021; 22: 645
- 13 Akimbekov NS, Digel I, Sherelkhan DK. et al. Vitamin D and phosphate interactions in health and disease. Adv Exp Med Biol 2022; 1362: 37-46
- 14 Zheng S, Chen Y, Zheng Y. et al. Correlation of serum levels of fibroblast growth factor 23 and Klotho protein levels with bone mineral density in maintenance hemodialysis patients. Eur J Med Res 2018; 23: 18
- 15 Bouksila M, Mrad M, Kaabachi W. et al. Correlation of Fgf23 and Balp with bone mineral density in hemodialysis patients. J Med Biochem 2019; 38: 418-426
- 16 Yilmaz VT, Ozdem S, Donmez L. et al. FGF-23, α-Klotho gene polymorphism and their relationship with the markers of bone metabolism in chronic peritoneal dialysis patients. Eurasian J Med 2015; 47: 115-125
- 17 Nakamichi Y, Udagawa N, Suda T. et al. Mechanisms involved in bone resorption regulated by vitamin D. J Steroid Biochem Mol Biol 2018; 177: 70-76
- 18 Agoro R, Ni P, Noonan ML. et al. Osteocytic FGF23 and its kidney function. Front Endocrinol (Lausanne) 2020; 11: 592
- 19 Komaba H, Kaludjerovic J, Hu DZ. et al. Klotho expression in osteocytes regulates bone metabolism and controls bone formation. Kidney Int 2017; 92: 599-611
- 20 Yamada S, Giachelli CM. Vascular calcification in CKD-MBD: Roles for phosphate, FGF23, and Klotho. Bone 2017; 100: 87-93