Журнал клинических случаев

Prognostic Analysis of Uremic Factors of Cardiovascular Risk, Including FGF-23, Klotho and Sclerostin, in Assessing the Progression of Vascular Calcification in CKD Patients: A Prospective Observation

Abstract

Milovanova LY, Lysenko LV, Moiseev SV, Fomin VV, Kozlov VV, Taranova MV, Milovanova SY, Reshetnikov V, Lebedeva MV and Androsova TV

Background: Cardiovascular Calcification (CVC) is a major contributor to the high incidence of Cardiovascular Events (CVE) in Chronic Kidney Disease (CKD). Early CVC markers are actively studied now in CKD for cardiorenoprotective strategy optimization. We have conducted a prospective comparative analysis testing the follow factors: FGF-23, Klotho, sclerostin, phosphate, parathyroid hormone serum levels, estimated Glomerular Filtration Rate (eGFR), central systolic Blood Pressure (BP) levels, as independent determinants of CVC. Materials and methods: A total of 131 CKD stage 2-5D patients were included. Serum FGF-23, Klotho, and sclerostin levels were measured by ELISA. Augmentation indices, central (aortal) BP (by «SphygmoCor»), valvular calcification score (by Echocardiography), and aortic calcinosis score (by abdominal aorta radiography), were performed. The observation period was 2 years. Results: According to Spearman`s correlation analysis, the percentage of calcification increase and the change in serum Klotho level were most related. According to ROC analysis, a decrease in Klotho serum level by 50 units or more is a significant predictor of an increase in aortic calcification by 50% or more with a sensitivity of 84% and a specificity of 75% Using logistic regression analysis, it was found that Klotho serum level ​