Low Klotho/Fibroblast Growth Factor 23 Ratio Is an Independent Risk Factor for Renal Progression in Chronic Kidney Disease: Finding From KNOW-CKDopen access
- Authors
- Kim, Hyo Jin; Kim, Yunmi; Kang, Minjung; Kim, Seonmi; Park, Sue Kyung; Sung, Suah; Hyun, Young Youl; Jung, Ji Yong; Ahn, Curie; Oh, Kook-Hwan
- Issue Date
- Jul-2022
- Publisher
- FRONTIERS MEDIA SA
- Keywords
- Klotho; fibroblast growth factor 23; chronic kidney disease; renal progression; mortality
- Citation
- FRONTIERS IN MEDICINE, v.9
- Journal Title
- FRONTIERS IN MEDICINE
- Volume
- 9
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/85522
- DOI
- 10.3389/fmed.2022.904963
- ISSN
- 2296-858X
- Abstract
- BackgroundWe aimed to evaluate soluble Klotho and circulating fibroblast growth factor 23 (FGF23) ratio as a risk factor for renal progression, cardiovascular (CV) events, and mortality in chronic kidney disease (CKD). MethodsWe analyzed 2,099 subjects from a CKD cohort whose soluble Klotho and C-terminal FGF23 levels were measured at enrollment. The Klotho to FGF23 ratio was calculated as Klotho values divided by FGF23 values + 1 (hereinafter called the Klotho/FGF23 ratio). Participants were categorized into quartiles according to Klotho/FGF23 ratio. The primary outcome was renal events, defined as the doubling of serum creatinine, 50% reduction of estimated glomerular filtration rate from the baseline values, or development of end-stage kidney disease. The secondary outcomes consisted of CV events and death. Changes in CV parameters at the time of enrollment and during follow-up according to the Klotho/FGF23 ratio were also examined. ResultsDuring the follow-up period of 64.0 +/- 28.2 months, 735 (35.1%) and 273 (13.0%) subjects developed renal events and composite outcomes of CV events and death, respectively. After adjustment, the first (HR: 1.36; 95% CI: 1.08-1.72, P = 0.010) and second (HR: 1.45; 95% CI: 1.15-1.83, P = 0.002) quartiles with regard to the Klotho/FGF23 ratio showed elevated risk of renal events as compared to the fourth quartile group. There was no significant association between Klotho/FGF23 ratio and the composite outcome of CV events and death. The prevalence of left ventricular hypertrophy and vascular calcification was higher in the low Klotho/FGF23 ratio quartiles at baseline and at the fourth-year follow-up. ConclusionsLow Klotho/FGF23 ratio was significantly associated with increased renal events in the cohort of Korean predialysis CKD patients.
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