Changes Of Serum Levels Of Klotho Protein And 1,25?OH?₂D₃ And Its Relationship With Calcium And Phosphorus In 3-5 Stage Patiens With Chronic Kidney Disease

Objective:Through the experimental determination of chronic kidney disease stage 3-5 patients serum Klotho and 1.25(OH)2D3 level changes.The relationship of the two respectively with serum creatinine,serum calcium and phosphorus,iPTH;and the correlation between them were studied.Klotho proteins and 1,25(OH)2D3 in stage 3-5 chronic kidney disease on calcium and phosphorus metabolism regulation function.Methods:A total of One hundred and fifty-two non-dialysis patients with chronic kidney disease stage 3-5 who were admitted in the Nephrology Department or outpatient of the Fujian Provincial People's Hospital were enrolled.And the healthy volunteers who had been examined in the hospital during the same period were selected as the normal control group,with 30 cases.The serum Klotho protein?1,25(OH)2D3 level and iPTH were detected by double antibody sandwich enzyme-linked immunosorbent assay(ELISA).Serum calcium(Ca),phosphorus(P)and serum creatinine(Scr)levels were measured by automatic biochemical analyzer(BECKMAN C800).According to the MDRD fonnula(estimated glomerular filtration rate,eGFR),the glomerular rate filtration was calculated,and the correlation between serum Klotho protein,1,25(OH)2D3 level and other indicators was analyzed.Results:1.On the whole,the level of Klotho protein and 1,25(OH)2D3 in CKD3-5 patients was decreased with the progress of CKD and the results of variance analysis showed that the effect of CKD stage on Klotho protein and 1.25(OH)2D3 level was statistically significant(P=0.000).In the indexes of reaction calcium and phosphorus metabolism,the levels of PTH,blood phosphorus and calcium phosphorus products were significantly increased with the progress of CKD,while the level of blood calcium decreased with the progress of CKD.2.The correlation analysis results showed that the Klotho protein level in CKD 3-5 patients was positively correlated with the level of 1,25(OH)2D3(r=0.236,P<0.01).The level of Klotho,1,25(OH)2D3 was significantly correlated with the calcium and phosphorus metabolism index and e GFR.Among them,the Klotho and blood phosphorus(r = 0.502.P<0.01),and the calcium-phosphorus product(r = 0.417,P<0.01),serum creatinine(r = 0.664,P<0.01),iPTH(r = 0.580,P<0.01),age(r = 0.05,P = 0.05)there are negative correlation,and the blood calcium(r = 0.357,P<0.01),eGFR(r = 0.619,P<0.01)positive correlation;whilel.25(OH)2D3 and blood phosphorus(r = 0.234,P<0.01),and the calcium-phosphorus product(r = 0.015,P<0.01),serum creatinine(r = 0.335,P<0.01),iPTH(r = 0.305,P<0.01)there are negative correlation,and the blood calcium(r = 0.272,P<0.01),eGFR(r = 0.272,P<0.01)positive correlation.3.The data of Klotho and and 1,25(OH)2D3 were divided into two levels,which were divided into two levels,and the differences between the metabolic indexes of renal calcium and phosphorus were compared between different levels.The results showed that there were significant differences in the metabolic indexes of calcium and phosphorus in the group divided by Klotho level.There was no significant difference in the calcium and phosphorus metabolism indices in the groups divided into different levels and 1.25(OH)2D3.4.Multivariate stepwise linear regression analysis showed that eGFR was an independent influence factor of serum Klotho level,and serum creatinine was independent influence factor of serum 1,25(OH)2D3 level.Besides,in this study,The results showed that eGFR had the most influence on blood phosphorus level,followed by Klotho.And the results showed that blood phosphorus level has the greatest impact on iPTH,followed by klotho.Conclusions:1.The levels of klotho and 1,25(OH)2D3 were gradually reduced with the progress of CKD,and there was a significant positive correlation between them.But on the whole,as a result of the change in CKD,it's the opposite of the iPTH,the blood phosphorus,the calcium phosphate product,the same as the blood calcium and the eGFR.2.It's indicate that that level of Klotho protein in chronic renal disease 3-5 term is next to eGFR in the level of Klotho protein,and therefore the change of Klotho level in the early stage had some significance in correcting metabolic.disorder.3.In chronic kidney disease,there is a positive correlation between serum Klotho and 1,25(OH)2D3,therefore,it can provide clinical treatment ideas to increase drug-induced klotho protein,which can delay the progression of chronic kidney disease.