Ana Luísa Ribeiro1, Filipa Mendes2, Eduarda Carias2, Fátima Rato3, Nélio Santos3, Pedro Leão Neves4, Ana Paula Silva4. 1. Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal. Electronic address: al.ribeir@gmail.com. 2. Department of Nephrology, Centro Hospitalar Universitário do Algarve, Faro, Portugal. 3. Pathology Clinic, Centro Hospitalar Universitário do Algarve, Faro, Portugal. 4. Department of Nephrology, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.
Abstract
BACKGROUND: The aim of our study was to evaluate the relevance of FGF23-klotho axis in the predisposition for bone fractures in type 2 diabetic patients with early chronic kidney disease. METHODS: In a prospective study we included 126 type 2 diabetic patients with CKD stages 2-3 (from 2010 to 2017). We used descriptive statistics, ANOVA and chi-square test. Our population was divided into two groups according to the occurrence of a bone fracture event or not, and the groups were compared considering several biological and laboratorial parameters. We employed a multiple regression model to identify risk factors for bone fracture events and hazard ratios (HR) were calculated using a backward stepwise likelihood ratio (LR) Cox regression. RESULTS: Patients with a fracture event displayed higher levels of FGF-23, Phosphorus, PTH, TNF-α, OxLDL, HOMA-IR, calcium × phosphorus product and ACR and lower levels of Osteocalcin, α-Klotho, 25(OH)D3 and eGFR compared with patients without a fracture event (p < 0.001). The number of patients with a fracture event was higher than expected within inclining CKD stages (χ2, p = 0.06). The occurrence of fracture and the levels of TNF- α, klotho, 25(OH)D3 and OxLDL were found to predict patient entry into RRT (p < 0.05). Age, osteocalcin, α-Klotho and FGF-23 independently influenced the occurrence of bone fracture (p < 0.05). CONCLUSIONS: α-Klotho and FGF-23 levels may have a good clinical use as biomarkers to predict the occurrence of fracture events.
BACKGROUND: The aim of our study was to evaluate the relevance of FGF23-klotho axis in the predisposition for bone fractures in type 2 diabeticpatients with early chronic kidney disease. METHODS: In a prospective study we included 126 type 2 diabeticpatients with CKD stages 2-3 (from 2010 to 2017). We used descriptive statistics, ANOVA and chi-square test. Our population was divided into two groups according to the occurrence of a bone fracture event or not, and the groups were compared considering several biological and laboratorial parameters. We employed a multiple regression model to identify risk factors for bone fracture events and hazard ratios (HR) were calculated using a backward stepwise likelihood ratio (LR) Cox regression. RESULTS:Patients with a fracture event displayed higher levels of FGF-23, Phosphorus, PTH, TNF-α, OxLDL, HOMA-IR, calcium × phosphorus product and ACR and lower levels of Osteocalcin, α-Klotho, 25(OH)D3 and eGFR compared with patients without a fracture event (p < 0.001). The number of patients with a fracture event was higher than expected within inclining CKD stages (χ2, p = 0.06). The occurrence of fracture and the levels of TNF- α, klotho, 25(OH)D3 and OxLDL were found to predict patient entry into RRT (p < 0.05). Age, osteocalcin, α-Klotho and FGF-23 independently influenced the occurrence of bone fracture (p < 0.05). CONCLUSIONS: α-Klotho and FGF-23 levels may have a good clinical use as biomarkers to predict the occurrence of fracture events.
Authors: Ana P Silva; Carla S B Viegas; Patrícia Guilherme; Nelson Tavares; Carolina Dias; Fátima Rato; Nélio Santos; Marília Faísca; Edgar de Almeida; Pedro L Neves; Dina C Simes Journal: Diagnostics (Basel) Date: 2022-02-15
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