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dc.contributor.authorTan, S-J
dc.contributor.authorSmith, ER
dc.contributor.authorHolt, SG
dc.contributor.authorHewitson, TD
dc.contributor.authorToussaint, ND
dc.date.accessioned2021-02-04T01:59:42Z
dc.date.available2021-02-04T01:59:42Z
dc.date.issued2017-06-01
dc.identifierpii: sfw146
dc.identifier.citationTan, S. -J., Smith, E. R., Holt, S. G., Hewitson, T. D. & Toussaint, N. D. (2017). Soluble klotho may be a marker of phosphate reabsorption. CLINICAL KIDNEY JOURNAL, 10 (3), pp.397-404. https://doi.org/10.1093/ckj/sfw146.
dc.identifier.issn2048-8505
dc.identifier.urihttp://hdl.handle.net/11343/259543
dc.description.abstractBackground: Membrane-bound α-klotho functions as a co-receptor with fibroblast growth factor receptor at the renal tubule conferring specificity to fibroblast growth factor-23 (FGF-23), allowing it to inhibit tubular phosphate reabsorption at physiological concentrations. α-klotho also exists as a soluble protein. However, the complex interrelationships between soluble α-klotho (sKl), FGF-23 and phosphate reabsorption are poorly understood, with little known about the links between sKl, FGF-23 and phosphate reabsorption in chronic kidney disease (CKD). This study addresses this issue in a cohort of patients with and without CKD. Methods: We conducted a single-centre, cross-sectional study of contemporaneously obtained samples of blood and 24-h urine biochemistry along with sKl and intact FGF-23 (iFGF-23) from non-dialysis-dependent CKD patients and healthy volunteers. Pearson's correlation coefficients were used to determine correlations between natural log-transformed (Ln) sKl and iFGF-23 with other parameters of interest. Backward multivariate analysis was undertaken to evaluate the relationship between mineral parameters. Results: One hundred and sixteen participants (77 with CKD and 39 healthy volunteers) were studied, of which 74 (63.8%) were male. The median age was 61 (interquartile range 49-71) years. Those with CKD had lower sKl (408 versus 542 pg/mL), higher iFGF-23 (94 versus 41 pg/mL), higher fractional excretion of phosphate (25.05 versus 10.98%) and lower daily urinary phosphate excretion (UPE) (24.8 versus 32.3 mmol/L) compared with healthy volunteers (all P  ≤ 0.002). Age correlated inversely and estimated glomerular filtration rate (eGFR) correlated positively with phosphate reabsorption and Ln(sKl), while the opposite was seen with Ln(iFGF23). Upon multivariate analysis, eGFR, Ln(sKl) and parathyroid hormone were independently associated with phosphate reabsorption, whereas Ln(iFGF-23) was not, after adjustment for age. Conclusions: Abnormalities in phosphate regulatory pathways are disturbed early in CKD. While iFGF-23 is associated with phosphate excretion on univariate analyses, sKl demonstrates a significant association with phosphate reabsorption independent of iFGF-23, and this relationship deserves further exploration.
dc.languageEnglish
dc.publisherOXFORD UNIV PRESS
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0
dc.titleSoluble klotho may be a marker of phosphate reabsorption
dc.typeJournal Article
dc.identifier.doi10.1093/ckj/sfw146
melbourne.affiliation.departmentMedicine (RMH)
melbourne.affiliation.facultyMedicine, Dentistry & Health Sciences
melbourne.source.titleClinical Kidney Journal
melbourne.source.volume10
melbourne.source.issue3
melbourne.source.pages397-404
dc.rights.licenseCC BY-NC
melbourne.elementsid1215040
melbourne.contributor.authorHewitson, Timothy
melbourne.contributor.authorToussaint, Nigel
melbourne.contributor.authorHolt, Stephen
melbourne.contributor.authorSmith, Edward
dc.identifier.eissn2048-8513
melbourne.accessrightsOpen Access


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