| Objective: To investigate the correlation between serum FGF-23,Klotho protein levels and the decrease of calcaneal bone mineral density(BMD)in maintenance hemodialysis(MHD)patients,to search for new markers for the assessment of BMD in MHD patients,and to provide a new target for the treatment of osteoporosis in MHD patients.Method:(1).This study enrolled 69 patients(36males,33females)with end-stage renal disease who received MHD therapy in the Blood Purification Center of Neijiang Second People’s Hospital from September to October 2016 as the case group(group A),the related parameters of calcaneus’ BMD—Bone Quality Index(BQI)and T-score in MHD patients were detected by quantitative ultrasound system(QUS).The patients were stratified into three subgroups:normal bone mass group(groupA1),osteopenia group(group A2)and osteoporosis group(group A3)according to the diagnostic criteria of osteoporosis recommended by WHO.A total of 36 healthy volunteers with normal BMD detected by QUS received physical examination in the Medical Examination Center of Neijiang Second People’s Hospital from September to October 2016 were included as the control group(group B)in this study.(2).The general clinical data of patients such as gender,age,duration of dialysis treatment,etc.were collected,the creatinine,blood urea nitrogen,calcium,phosphorus and PTH of the case group were measured.(3).Blood samples of group A and group B were collected,the levels of serum FGF-23,Klotho and 1,25(OH)2D were tested by ELISA in both groups of A and B.(4).The serum levels of FGF-23,Klotho and 1,25(OH)2D were compared between group A and group B,the correlation between serum FGF-23,Klotho protein levels and PTH,1,25(OH)2D,Ca,P and other clinical indicators were analyzed;the association between BMD related parameters—BQI,T-score and serum FGF-23,Klotho protein levels in MHD patients were analyzed;the related factors of the decline of calcaneus’ BMD in MHD patients were also analyzed.Result:(1).Among the 68 MHD patients,the incidence of the decrease of calcaneal BMD was 78%,including 36 patients were osteopenia(52%),18 patients were osteoporosis(26%).(2).The independent-samples t-test was used to analyzed the levels of serum FGF-23,Klothoand1,25(OH)2D between group A and group B.The serum Klotho protein levels in group A was significantly lower than those in group B(P < 0.001),the serum FGF-23 and 1,25(OH)2D levels of group A was significantly higher than those of group B(P < 0.001);further analyzed by variance analysis,the serum Klotho protein levels in group A1,group A2 and group A3 were still significantly lower than those in group B,serum FGF-23 and 1,25(OH)2D levels of group A1,groupA2 and groupA3 were also significantly higher than those of group B,the differences were statistically significant(P < 0.001).(3).Among group A1,group A2,group A3,the age gradually increased,the serum Klotho protein level and BQI gradually decreased,the negative value of T-Score gradually increased,analyzed by variance analysis: there were significant differences in age,Klotho protein level,BQI,T-score among group A1,group A2 and group A3(P < 0.05).(4).Analyzed by Pearson correlative analysis: there was no correlation between serum Klotho protein level and blood test indicators in MHD patients(P> 0.05);serum FGF-23 was positively correlated with Ca(r=.043,P < 0.001)and P(r=0.36,P=0.002)in MHD patients.(5).Analyzed by Pearson correlative analysis:in MHD patients,there were correlation between BQI and age(r =-0.50,P<0.001),treatment duration(r =-0.29,P = 0.016)and Klotho protein level(r = 0.58,P<0.001),there were correlation between T-score and age(r =-0.49,P<0.001),treatment duration(r =-0.28,P = 0.017)and Klotho protein level(r = 0.55,P<0.001).Age,treatment duration were negatively correlated with calcaneus’ BMD,and serum Klotho protein level was positively correlated with calcaneus’ BMD.(6).According to binary logistic regression analysis,increase of age was the risk factor of decline of calcaneal BMD in MHD patients(OR=1.05,P=0.021),decrease of Klotho protein level was also the risk factor of decline of calcaneal BMD in MHD patients(OR=2.43,P=0.002).Conclusion:(1).The incidence of the decline of calcaneal BMD was high in MHD patients.(2).In MHD patients,the serum FGF-23 level was related to phosphorus and calcium metabolism,but there was no correlation between serum FGF-23 level and calcaneal BMD.(3).In MHD patients,the serum Klotho protein was a protective factor for decrease of calcaneal BMD.(4).Increase of age was also a risk factor for decrease of calcaneal BMD in MHD patients. |
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