The Influence And Predictive Value Of Serum Klotho/FGF23 Adjustment Axis On Osteoporosis In Maintenance Hemodialysis Patient

Objective:Klotho protein and Fibroblast growth factor-23(FGF23)are key factors in regulating human mineral metabolism.This study aims to study the expression of Klotho and FGF23 in the serum of maintenance hemodialysis(MHD)patients.To explore the influence and predictive value of Klotho/FGF23 adjustment axis on osteoporosis in patients with MHD.Method:1.First,a total of 186 MHD patients admitted in the Hospital between March2020 and July 2020 was enrolled to cross-sectional analysis.The serum levels of general biochemical indexes and bone metabolism indexes of all selected patients were detected,and the serum Klotho and FGF23 levels were detected by enzymelinked immunosorbent assay(ELISA).Dual-energy X-rays were used to detect the bone mineral density(BMD)of the patients’ lumbar spine and left hip joint.The patients with MHD were divided into three groups: normal bone mass,osteopenia and osteoporosis according to the diagnostic criteria of osteoporosis recommended by WHO,and compared the differences in the above-mentioned detection indicators in each group.To analyze the correlation between Klotho,FGF23 and bone metabolism indexes,and to explore the influencing factors of chronic kidney disease-mineral and bone disorder(CKD-MBD)secondary osteoporosis in MHD patients.2.Secondly,There are 124 MHD patients in the Hospital between August 2016 and July 2020 were selected to conduct a retrospective cohort study.The patients were divided into high and low two groups according to the median level of Klotho detected in the previous period of the study.The incidence of osteoporosis between the two groups was compared,and to explore the value of Klotho in predicting the occurrence of osteoporosis in patients with maintenance hemodialysis.3.EXCEL 2007 and SPSS 22.0 software were used for data processing and analysis,P<0.05 was considered as statistically significant.Result:1.Correlation analysis of Klotho,FGF23,left hip T value and general indicators and bone metabolism indicators in all selected patients: there was a negative correction between Klotho and FGF23(r=-0.266,P<0.001),intact parathyroid hormone(i PTH;r=-0.23,P=0.002),phosphorus(P;r=-0.167,P=0.023),age(r=-0.186,P=0.011).FGF23 is negatively correlated with Klotho and calcium(Ca;r=-0.16,P=0.03),and positively correlated with i PTH(r=0.642;P<0.001),P(r=0.157;P=0.033)and bone metabolism indexes.The left hip T value was positively correlated with Klotho(r=0.513),and negatively correlated with FGF23(r=-0.544),bone metabolism indexes,age(r=-0.337),and dialysis age(r=-0.193)(all P<0.001).2.Comparison of Klotho,FGF23 and bone metabolism indexes in maintenance hemodialysis patients’ bone mass grouping: there were significant differences in serum Klotho,FGF23 and bone metabolism indexes levels among the three groups divided by BMD(all P<0.001).The osteoporosis group had the lowest level of Klotho,and the serum levels of FGF23,i PTH and bone metabolism index were the highest.There was no difference in 25-hydroxyvitamin D among the three groups(P>0.05),but the serum level of 25-hydroxyvitamin D in the osteoporosis group was lower than that of the other two groups.3.Multiple regression analysis showed that Klotho,FGF23,age,dialysis age,i PTH,25-hydroxyvitamin D are all factors that affect bone mineral density,and the differences were statistically significant;multiple logistics regression analysis showed that i PTH and age were the risk of osteoporosis Factors,Klotho was an independent protective factor for osteoporosis.4.The MHD patients in retrospective cohort study were divided into high and low groups according to the previously measured median level of Klotho.There was significant difference in left hip T value between two groups(P=0.001),that is,the incidence of osteoporosis between two groups were differences.Chi-square test showed that the incidence of osteoporosis was higher in the low Klotho level group(79.0%,P<0.001,OR=2.651,95%CI: 1.534-4.459).Multiple logistics regression analysis showed that Klotho is an independent protective factor for osteoporosis.Klotho could be used as a predictor of osteoporosis.Conclusion:1.Klotho protein and FGF23 are closely related to bone metabolism and bone density,and they can be used as biochemical indicators for monitoring abnormal mineral and bone metabolism in hemodialysis patients.2.In maintenance hemodialysis patients,iPTH and age are risk factors,and Klotho is independent protective factor for osteoporosis.3.The lower the serum Klotho level is,the higher the risk of osteoporosis in maintenance hemodialysis patients.In hemodialysis patients,Klotho can be used as a predictor and has certain predictive value of osteoporosis.