Ozeki Michishige, Fujita Shu-ichi, Kizawa Shun, Morita Hideaki, Sohmiya Koichi, Hoshiga Masaaki, Ishizaka Nobukazu
Department of Cardiology, Osaka Medical College, Takatsuki-shi Daigaku-machi 2-7, Osaka 569-8686, Japan.
BMC Nephrol. 2014 Sep 8;15:147. doi: 10.1186/1471-2369-15-147.
Expression and/or excretion of fibroblast growth factor-23 (FGF23) and its co-receptor Klotho are altered in patients with end-stage renal disease. The possibility that the FGF23/α-Klotho system mediates the aggravated cardiovascular outcome among patients with chronic kidney disease (CKD) has been suggested. We determined whether FGF23 and α-Klotho concentrations are altered among patients with reduced renal function and proteinuria.
Serum FGF23 and α-Klotho were measured in cardiology patients who were not undergoing chronic hemodialysis. Estimated glomerular filtration rate (eGFR) was correlated negatively with FGF23 and positively with α-Klotho.
The correlation between FGF23 and the renal tubular maximum reabsorption rate of phosphate to the GFR (TmP/GFR) was not significant, but that between FGF23 and serum calcium or inorganic phosphate was significant among patients with an estimated GFR of less than 60 mL/min/m(2). By stepwise multivariate regression analysis, eGFR was selected as significant predictor for FGF23 or α-Klotho among patients with an estimated GFR of less than 60 mL/min/m(2); however, urine albumin/creatinine ratio was not selected as a predictor for FGF23 or α-Klotho irrespective of the eGFR levels. In patients with eGFR of <60 mL/min/1.73 m(2), UACR was significantly associated with log(FGF23); but, this association did not remain statistically significant in a multivariate model.
Among cardiology patients with various stages of CKD, serum concentrations of FGF23 and α-Klotho were associated with renal function, but not with the extent of proteinuria.
终末期肾病患者中，成纤维细胞生长因子23（FGF23）及其共受体α-klotho的表达和/或排泄会发生改变。有研究表明，FGF23/α-klotho系统可能介导了慢性肾脏病（CKD）患者心血管不良结局的加重。我们研究了肾功能减退和蛋白尿患者的FGF23和α-klotho浓度是否发生改变。
检测未接受慢性血液透析的心脏病患者的血清FGF23和α-klotho水平。估算肾小球滤过率（eGFR）与FGF23呈负相关，与α-klotho呈正相关。
在估算肾小球滤过率低于60 mL/min/m²的患者中，FGF23与肾小管对磷的最大重吸收率与肾小球滤过率的比值（TmP/GFR）之间无显著相关性，但FGF23与血清钙或无机磷之间存在显著相关性。通过逐步多元回归分析，在估算肾小球滤过率低于60 mL/min/m²的患者中，eGFR被选为FGF23或α-klotho的显著预测因子；然而，无论eGFR水平如何，尿白蛋白/肌酐比值均未被选为FGF23或α-klotho的预测因子。在eGFR<60 mL/min/1.73 m²的患者中，尿白蛋白肌酐比值（UACR）与log(FGF23)显著相关；但在多变量模型中，这种相关性不再具有统计学意义。
在不同阶段CKD的心脏病患者中，血清FGF23和α-klotho浓度与肾功能相关，但与蛋白尿程度无关。
