Serum soluble ?-Klotho in hemodialysis patients

Yokoyama, Keitaro; Imura, Akihiko; Ohkido, Ichiro; Maruyama, Yukio; Yamazaki, Y.; Higuchi, Hisashi; Urae, Jun; Saito, Hiroshi; Nabeshima, Yo‐ichi; Hosoya, Tatsuo

doi:10.5414/cn107204

Cited by 39 publications

(34 citation statements)

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“…Current data further suggested that many indicators of mineral metabolism (serum phosphate, calcium, iPTH, and FGF-23) were closer to normal levels in MHD patients with RRF (urinary output .200 ml/d; GFR interquartile range, 1.8-5.4 ml/min per 1.73 m 2 ) than patients without RRF (urinary output #200 ml/d). In addition, the circulating levels of a-Klotho in MHD patients were lower than the reported normal level (22), which was concordant with a previous study (23). Shimamura et al reported that a-Klotho was positively associated with estimated GFR in patients with stage 1-5 CKD (24).…”

Section: Discussionsupporting

confidence: 80%

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Association of Circulating Fibroblast Growth Factor-23 with Renal Phosphate Excretion among Hemodialysis Patients with Residual Renal Function

Wang

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives High serum levels of fibroblast growth factor-23 (FGF-23) are associated with mortality in patients with ESRD, but whether it still acts as a phosphaturic factor is unknown. This study aimed to explore the role of circulating FGF-23 on urinary phosphate excretion and phosphate balance in maintenance hemodialysis (MHD) patients with residual renal function (RRF).Design, setting, participants, & measurements There were 134 MHD patients enrolled in this cross-sectional study from June to July 2010. Demographics, laboratory data, and excretion capacity of phosphate were recorded. Multivariable linear regression was used to analyze the relationship of serum phosphate and the tubular reabsorption rate of phosphate with other factors.Results The median age of the patients was 61.0 years and 47.8% were male. Thirty percent of the patients had high urinary output (.200 ml/d) accompanied by lower serum levels of phosphate, calcium, intact parathyroid hormone, and FGF-23 compared with those with low urine output (#200 ml/d). The independent predictors of serum phosphate were normalized protein nitrogen appearance, intact parathyroid hormone, and FGF-23 in the low urine output group and female sex and GFR in the high urine output group. The tubular reabsorption rate of phosphate decreased to 50% of the normal level in patients with RRF. Elevated circulating FGF-23 was significantly associated with lower tubular phosphate reabsorption after adjusting for GFR.Conclusions RRF is associated with significant capacity to excrete phosphate in MHD patients and high levels of serum FGF-23 may promote phosphate excretion by remnant nephrons.

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Section: Discussionsupporting

confidence: 80%

“…It may be explained by underuremic conditions in which there is a higher circulating concentration of FGF-23, and FGF-23 may bind to its receptor with low affinity without Klotho (48). The biologic role of circulating Klotho needs further investigation (23).…”

Section: Discussionmentioning

confidence: 99%

Association of Circulating Fibroblast Growth Factor-23 with Renal Phosphate Excretion among Hemodialysis Patients with Residual Renal Function

Wang

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…The studies indicated that sKlotho levels continuously declined with progressive degrees of severity of renal insufficiency and were negatively correlated to the stage of chronic renal disease [5,[7][8][9]. Recently, a Japanese study showed the sKlotho level was 430 (386, 540) pg/ml in MHD patients [10]. The sKlotho level was lower in our study (379.93±143.66 pg/ml) than in the foreign study, which may be associated with the lower renal function of patients when they start dialysis in China.…”

Section: Discussionmentioning

confidence: 99%

Circulating α-Klotho Levels in Hemodialysis Patients and Their Relationship to Atherosclerosis

Ren

et al. 2018

Kidney Blood Press Res

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Background/Aims: Serum soluble Klotho (sKlotho) plays a role in cardiovascular disease in some populations. However, information regarding the effect of serum sKlotho on atherosclerosis in patients on maintenance hemodialysis (MHD) is limited. Therefore, we tested the level of serum sKlotho in MHD patients to investigate atherosclerosis disease and determine the relationship between sKlotho and atherosclerosis. Methods: Using cross-sectional research, anthropometric and laboratory data were collected for 330 MHD patients. The levels of serum sKlotho before dialysis were tested by enzyme-linked immunosorbent assay. Carotid intima-middle thickness (cIMT) and the number of carotid artery atherosclerotic plaques were measured by color Doppler ultrasonography. The risk factors of atherosclerosis were explored by multivariate logistic regression analysis. Results: Among 330 MHD patients, the average serum sKlotho was (379.93±143.66) pg/ml. The level of serum sKlotho was positively related to hemoglobin (P< 0.05). It was negatively correlated with systolic pressure, pulse pressure, ultrafiltration volume, serum phosphorus, corrected serum calcium×phosphorus, high-sensitivity C-reactive protein (Hs-CRP), cIMT and carotid atherosclerotic plaque quantity and atherosclerosis (P< 0.05). Multivariate logistic regression analysis showed that age (OR = 1.108, 95% CI = 1.067 ∼ 1.151, P = 0.000), dry weight (OR = 1.050, 95% CI = 1.014 ∼ 1.088, P = 0.007), Hs-CRP (OR = 1.126, 95% CI = 1.005 ∼ 1.261, P = 0.041), and serum sKlotho (OR = 0.997, 95% CI = 0.995 ∼ 1.000, P = 0.032) were risk factors for atherosclerosis in MHD patients. Conclusion: Serum sKlotho was related to systolic pressure, pulse pressure, ultrafiltration volume, hemoglobin, serum phosphorus, corrected serum calcium×phosphorus, Hs-CRP, increased cIMT, carotid atherosclerotic plaque quantity and atherosclerosis. Age, dry weight, Hs-CRP, and serum sKlotho were risk factors for atherosclerosis in MHD patients. Serum sKlotho may be a novel risk factor for atherosclerosis in MHD patients.

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“…On the other hand, Pavik et al showed a progressive decrease of s-klotho with increasing CKD stage [15]. A significant reduction of s-klotho has been shown in HD patients [16,17]. In a recent large cohort study to determine the correlation between s-klotho and different CKD stages, Seiler et al did not find a significant difference of s-klotho concentrations between CKD stage 2, 3a, 3b and 4 patients [6].…”

Section: Discussionmentioning

confidence: 99%

Serum Klotho: Relation to Fibroblast Growth Factor-23 and Other Regulators of Phosphate Metabolism in Children with Chronic Kidney Disease

Sawires

Essam

Morgan

et al. 2015

Nephron

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FGF23 and Klotho synergize to regulate phosphate homeostasis by promoting renal phosphate excretion. Chronic kidney disease (CKD) may be viewed as a state of FGF23 resistance caused by Klotho deficiency. This viewpoint explains several observations on phosphate metabolism in CKD that lack mechanistic insights. Our objectives were to correlate serum klotho and FGF-23 with other variables that regulate phosphate metabolism. We studied 40 patients with CKD on conservative treatment (group A), 44 patients with end-stage renal disease (ESRD) on regular hemodialysis (group B), 40 kidney transplant recipients (KTR) (group C) and 40 healthy controls for measuring serum klotho and FGF-23. Blood samples were withdrawn for measuring the levels of serum Calcium (Ca), Phosphorus (P), alkaline phosphatase (ALP), 1,25 (OH)₂ D₃, intact parathyroid hormone (PTH), FGF-23 and α klotho. The mean levels of FGF-23 and α klotho in control group were 225.78 ± 111.05 pg/ml (range: 102.4, 418.5) and 6.78 ± 1.90 ng/ml (range: 4, 11), respectively. The mean levels of FGF-23 in the 3 studied groups were 1,034.2 ± 84.6, 1,288.7 ± 131.4 and 1,008.7 ± 117.6 pg/ml, respectively. The median levels of s-klotho in the 3 studied groups were 3.15, 2.3 and 2.95, respectively. It was found that FGF-23 was significantly increased and α klotho was significantly decreased in all patients when compared with those in the control group (p < 0.001, <0.001, respectively). We found that there was a significant inverse correlation between serum Ca and α klotho in the studied groups. There was no significant correlation between FGF-23 and α klotho in the studied groups (p > 0.05).We have shown that circulating s-klotho was not related to FGF-23 in CKD, dialysis and KTR patients. In addition, we demonstrated a novel association between serum Ca and s-klotho that needs to be further studied.

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Serum soluble ?-Klotho in hemodialysis patients

Cited by 39 publications

References 0 publications

Association of Circulating Fibroblast Growth Factor-23 with Renal Phosphate Excretion among Hemodialysis Patients with Residual Renal Function

Association of Circulating Fibroblast Growth Factor-23 with Renal Phosphate Excretion among Hemodialysis Patients with Residual Renal Function

Circulating α-Klotho Levels in Hemodialysis Patients and Their Relationship to Atherosclerosis

Serum Klotho: Relation to Fibroblast Growth Factor-23 and Other Regulators of Phosphate Metabolism in Children with Chronic Kidney Disease

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