Alfonso Farías-Basulto1, Héctor Ramón Martínez-Ramírez2, Erika Fabiola Gómez-García1, Alfonso Martín Cueto-Manzano2, Laura Cortés-Sanabria2, Luis Eduardo Hernández-Ramos3, Guadalupe Ramírez-López4, Francisco Mendoza-Carrera5. 1. Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, Centro Médico Nacional de Occidente, Delegación Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México; División de Medicina Molecular, Centro de Investigación Biomédica de Occidente, Delegación Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México. 2. Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, Centro Médico Nacional de Occidente, Delegación Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México. 3. División de Medicina Molecular, Centro de Investigación Biomédica de Occidente, Delegación Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México. 4. Unidad de Investigación Epidemiológica y en Servicios de Salud del Adolescente, Delegación Jalisco, Instituto Mexicano del Seguro Social, Tonalá, México. 5. División de Medicina Molecular, Centro de Investigación Biomédica de Occidente, Delegación Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México. Electronic address: francisco.mendozac@imss.gob.mx.
Abstract
INTRODUCTION: Diabetic nephropathy is a leading cause of chronic kidney disease (CKD). In diabetes, changes in serum levels of both soluble alpha Klotho (sKL) and fibroblast growth factor 23 (FGF-23) have been associated with CKD progression. OBJECTIVE: To evaluate the associations of circulating levels of sKL and FGF-23 with the presence of early nephropathy (EN) in diabetic patients. METHODS: A cross-sectional study in 136 Mexicans with type 2 diabetes mellitus (T2DM). Early nephropathy was defined as an estimated glomerular filtration rate (≥60 ml/min) and urinary albumin excretion (≥30 mg/g). Serum concentrations of sKL and FGF-23 were measured using ELISA. Associations were evaluated with multiple logistic regression. RESULTS: Fifty-two subjects had EN. Median values of sKL and FGF-23 for all individuals were 244 pg/mL (interquartile range [IQR]: 201-402) and 92 pg/mL (IQR: 39-507), respectively. A positive correlation was found between levels of sKL and FGF-23 (r = 0.38; p <0.001). FGF-23 levels correlated negatively with angiotensin-II receptor blocker therapy (ARB, r = 0.24; p <0.01). Subjects without EN were younger (59 vs. 63 years old, p = 0.02). Elevated concentrations of FGF-23 were negatively associated with EN (Odds Ratio [ORadjusted] = 0.29, 95% Confidence Interval [95% CI] = 0.13, 0.65). CONCLUSIONS: In Mexican diabetic patients, serum levels of FGF-23 were positively correlated with sKL but negatively correlated with ARB therapy. In addition, a higher concentration of FGF-23 reduced the odds of early nephropathy in patients with T2DM.
INTRODUCTION:Diabetic nephropathy is a leading cause of chronic kidney disease (CKD). In diabetes, changes in serum levels of both soluble alpha Klotho (sKL) and fibroblast growth factor 23 (FGF-23) have been associated with CKD progression. OBJECTIVE: To evaluate the associations of circulating levels of sKL and FGF-23 with the presence of early nephropathy (EN) in diabeticpatients. METHODS: A cross-sectional study in 136 Mexicans with type 2 diabetes mellitus (T2DM). Early nephropathy was defined as an estimated glomerular filtration rate (≥60 ml/min) and urinary albumin excretion (≥30 mg/g). Serum concentrations of sKL and FGF-23 were measured using ELISA. Associations were evaluated with multiple logistic regression. RESULTS: Fifty-two subjects had EN. Median values of sKL and FGF-23 for all individuals were 244 pg/mL (interquartile range [IQR]: 201-402) and 92 pg/mL (IQR: 39-507), respectively. A positive correlation was found between levels of sKL and FGF-23 (r = 0.38; p <0.001). FGF-23 levels correlated negatively with angiotensin-II receptor blocker therapy (ARB, r = 0.24; p <0.01). Subjects without EN were younger (59 vs. 63 years old, p = 0.02). Elevated concentrations of FGF-23 were negatively associated with EN (Odds Ratio [ORadjusted] = 0.29, 95% Confidence Interval [95% CI] = 0.13, 0.65). CONCLUSIONS: In Mexican diabeticpatients, serum levels of FGF-23 were positively correlated with sKL but negatively correlated with ARB therapy. In addition, a higher concentration of FGF-23 reduced the odds of early nephropathy in patients with T2DM.