Cardiovascular

Changes of serum fibroblast growth factor 23 (FGF23) and Klotho in diabetic kidney disease and their correlation with coronary artery calcification: a retrospective study.

Hong Y, Wang J, et al. • Archives of endocrinology and metabolism • 2026

PubMed 42905600 DOI 10.20945/2359-4292-2026-0125
TL;DR

FGF23 and Klotho were associated with renal impairment and CAC in patients with DKD and may serve as potential biomarkers of renal and cardiovascular risk.

Key Findings

Results

Patients with diabetic kidney disease had higher serum FGF23 and lower serum Klotho than age- and diabetes-matched controls.

  • Retrospective analysis of 176 DKD patients and 160 age- and diabetes-matched controls.
  • Serum FGF23 and Klotho were measured by enzyme-linked immunosorbent assay.
  • The abstract reports that FGF23 levels were significantly higher and Klotho levels were lower in DKD than in controls; specific values are not given in the abstract.
Results

FGF23 correlated negatively with eGFR and positively with albumin-to-creatinine ratio and blood urea nitrogen.

  • Correlation analysis was performed between serum FGF23 and renal function indices in DKD patients.
  • Higher FGF23 tracked with worse renal function markers (lower eGFR, higher ACR, higher BUN).
  • Correlation coefficients are not given in the abstract.
Results

Klotho showed the opposite pattern: positive correlation with eGFR and negative correlations with albumin-to-creatinine ratio and blood urea nitrogen.

  • Lower Klotho tracked with worse renal function markers.
  • Correlation analysis was performed in the DKD cohort.
  • Coefficients are not given in the abstract.
Results

DKD patients with coronary artery calcification had higher FGF23 and lower Klotho than those without CAC.

  • CAC was assessed by CAC scoring.
  • Levels were compared between patients with and without CAC.
  • Exact values are not given in the abstract.
Results

Both FGF23 and Klotho discriminated the presence of CAC on ROC analysis, with FGF23 having a higher area under the curve than Klotho.

  • Receiver operating characteristic analysis was used to assess discrimination of CAC.
  • FGF23 showed a higher AUC than Klotho.
  • Specific AUC values, cutoffs, sensitivity and specificity are not given in the abstract.
Results

FGF23 and Klotho were associated with CAC severity in correlation analysis.

  • Correlation analysis between the biomarkers and CAC score confirmed the association with CAC severity.
  • The abstract states this further confirmed the association, with no coefficients reported.

What This Means

This study looked at two blood markers, FGF23 and Klotho, in 176 people with diabetic kidney disease and 160 people with diabetes who were similar in age but did not have kidney disease. People with diabetic kidney disease tended to have higher FGF23 and lower Klotho. Higher FGF23 and lower Klotho also went along with worse kidney measures, such as lower filtering ability (eGFR), more protein leaking into urine, and higher blood urea nitrogen. Among the kidney disease patients, those with calcium build-up in the heart's arteries (coronary artery calcification) had higher FGF23 and lower Klotho. Both markers could help tell patients with and without calcification apart, and FGF23 did this somewhat better than Klotho. Both markers also tracked with how severe the calcification was. This research suggests that FGF23 and Klotho may be useful indicators of kidney damage and heart-vessel risk in people with diabetic kidney disease. However, the study was retrospective, so it shows associations rather than proving cause, and it does not show whether using these markers would improve patient care.

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Citation

Hong Y, Wang J, Lu Q, Sun W, Sun J. (2026). Changes of serum fibroblast growth factor 23 (FGF23) and Klotho in diabetic kidney disease and their correlation with coronary artery calcification: a retrospective study.. Archives of endocrinology and metabolism. https://doi.org/10.20945/2359-4292-2026-0125