Plasmatic Klotho and FGF23 Levels as Biomarkers of CKD-Associated Cardiac Disease in Type 2 Diabetic Patients.
Ana Paula Silva, Filipa Mendes, Eduarda Carias, Rui Baptista Gonçalves, André Fragoso, Carolina Dias, Nelson Tavares, Hugo Mendonça Café, Nélio Santos, Fátima Rato, Pedro Leão Neves, Edgar Almeida
Author Information
Ana Paula Silva: Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal. anapassionara@gmail.com.
Filipa Mendes: Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal. filipabritomendes@gmail.com. ORCID
Eduarda Carias: Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal. eduardaccarias@gmail.com.
Rui Baptista Gonçalves: Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 8005-139 Faro, Portugal. rui.baptistagoncalves@gmail.com. ORCID
André Fragoso: Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal. matinhosfragoso@gmail.com.
Carolina Dias: Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 8005-139 Faro, Portugal. diascarolinaj@gmail.com.
Nelson Tavares: Cardiology Department, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal. nelson.tavares63@gmail.com.
Hugo Mendonça Café: Cardiology Department, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal. hu.cafe@gmail.com.
Nélio Santos: Clinic Pathology Department, Centro Hospitalar Universitário do Algarve, 8000-836, Faro, Portugal. neliofilipe.santos@gmail.com.
Fátima Rato: Clinic Pathology Department, Centro Hospitalar Universitário do Algarve, 8000-836, Faro, Portugal. fatima.rato@gmail.com.
Pedro Leão Neves: Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal. pleaon@hotmail.com.
Edgar Almeida: Faculdadade de Medicina da Universidade de Lisboa, 1600-190 Lisboa, Portugal. edealmeida@mail.telepac.pt. ORCID
BACKGROUND: Research over the past decade has focused on the role of Klotho as a cardio protective agent that prevents the effects of aging on the heart and reduces the burden of cardiovascular disease CVD. The role of the interaction between fibroblast growth factor 23-(FGF-23)/Klotho in Klotho-mediated actions is still under debate. The main objective was to ascertain the potential use of plasmatic Klotho and FGF23 as markers for CKD-associated cardiac disease and mortality. METHODS: This was a prospective analysis conducted in an outpatient diabetic nephropathy clinic, enrolling 107 diabetic patients with stage 2⁻3 CKD. Patients were divided into three groups according to their left ventricular mass index and relative wall thickness. RESULTS: Multinomial regression analysis demonstrated that low Klotho and higher FGF-23 levels were linked to a greater risk of concentric hypertrophy. In the generalized linear model (GLM), Klotho, FGF-23 and cardiac geometry groups were statistically significant as independent variables of cardiovascular hospitalization ( = 0.007). According to the Cox regression model, fatal cardiovascular events were associated with the following cardiac geometric classifications; eccentric hypertrophy ( = 0.050); concentric hypertrophy ( = 0.041), and serum phosphate ≥ 3.6 mg/dL ( = 0.025), FGF-23 ≥ 168 ( = 0.0149), α-klotho < 313 ( = 0.044). CONCLUSIONS: In our population, Klotho and FGF23 are associated with cardiovascular risk in the early stages of CKD.
