Plasmatic Klotho and FGF23 Levels as Biomarkers of CKD-Associated Cardiac Disease in Type 2 Diabetic Patients

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Klotho is recognized for its cardio-protective effects, mitigating aging-related heart conditions and cardiovascular disease (CVD).
• The interplay between fibroblast growth factor 23 (FGF-23) and Klotho in mediating these protective actions requires further elucidation.
• Investigating plasmatic Klotho and FGF-23 as potential biomarkers for cardiac complications and mortality in chronic kidney disease (CKD) is crucial.

Purpose of the Study:

• To evaluate the utility of serum Klotho and FGF-23 levels as predictive markers for cardiac disease and mortality in patients with early-stage CKD.
• To explore the association between Klotho, FGF-23, and cardiac structural changes in diabetic nephropathy patients.

Main Methods:

• A prospective study involving 107 patients with stage 2-3 CKD and diabetic nephropathy.
• Patients were stratified into three groups based on left ventricular mass index and relative wall thickness.
• Statistical analyses included multinomial regression, generalized linear models (GLM), and Cox regression.

Main Results:

• Low Klotho and elevated FGF-23 levels correlated with an increased risk of concentric hypertrophy.
• Klotho, FGF-23, and cardiac geometry were significant independent predictors of cardiovascular hospitalization (p = 0.007).
• Risk factors for fatal cardiovascular events included eccentric hypertrophy (p = 0.050), concentric hypertrophy (p = 0.041), elevated serum phosphate (≥ 3.6 mg/dL), higher FGF-23 (≥ 168), and lower α-Klotho (< 313).

Conclusions:

• Klotho and FGF-23 levels are significantly associated with cardiovascular risk in patients during the early stages of CKD.
• These findings highlight the potential of Klotho and FGF-23 as early biomarkers for cardiovascular complications in CKD.