标题：Correlation between Soluble alpha-Klotho and Renal Function in Patients with Chronic Kidney Disease: A Review and Meta-Analysis
作者：Wang, Qinglian; Su, Wenyan; Shen, Zhenwei; Wang, Rong
作者机构：[Wang, Qinglian; Su, Wenyan; Wang, Rong] Shandong Univ, Dept Nephrol, Shandong Prov Hosp, Jinan, Shandong, Peoples R China.; [Shen, Zhenwei] Qilu Ph 更多
通讯作者地址：[Wang, R]Shandong Univ, Dept Nephrol, Shandong Prov Hosp, Jinan, Shandong, Peoples R China.
来源：BIOMED RESEARCH INTERNATIONAL
摘要：Objective. Over decades, numerous inconsistent studies are reported on the relationship between soluble alpha-Klotho and renal function in patients with chronic kidney disease (CKD). This study aims to perform a meta-analysis to figure out the correlations between soluble alpha-Klotho and renal function in patients with CKD. Materials and Methods. We searched medical and scientific literature databases, PubMed and EMBASE (from the inception to October 2017), for publications that reported studies on associations between soluble alpha-Klotho and renal function in patients with CKD. Only publications in English were extracted. Summary correlation coefficient (r) values were extracted from each study, and 95% confidence intervals (CIs) were calculated. Publication bias was tested, and sensitivity and subgroup analyses were performed to investigate potential heterogeneity. Results. Of 611 studies, 9 publications with 1457 patients were included into the analysis. The following data were extracted from the literature: first author, year of publication, research region, research index, sample size, average age and Pearson or Spearman correlation coefficient, study design, the alpha Klotho/FGF23 assays utilized, full length, or the C-terminal fragment of FGF23. The pooled r between alpha-Klotho and estimated glomerular filtration rate (eGFR), FGF-23 were 0.35 (95% CI, 0.23 similar to 0.46, and P<0.05), -0.10 (95% CI, -0.19 similar to 0.01, and P<0.05) with remarkable significance, indicating moderate heterogeneity. There was no significant heterogeneity between subgroups in analyses of alpha-Klotho and eGFR stratified by research region, mean age, and eGFR, but heterogeneity exists in analyses of alpha-Klotho and FGF-23 stratified by research region. There was no significant correlation between a-klotho and Ca and PTH and PHOS. There was no evidence of publication bias with Egger's test (p=0.360) or with Begg's test (p= 0.902) and the distribution of funnel plots was symmetrical in all of our analysis. Conclusions. There exists a significant positive correlation between soluble alpha-Klotho and eGFR in patients with CKD. Also, a significant negative correlation between alpha-Klotho and FGF23 levels is proven. This raises hope to employ alpha Klotho and FGF23 as early biomarkers of CKD. However, further large prospective follow-up researches are needed to validate this hypothesis and to explore whether maintaining or elevating the Klotho level could improve renal function and complications in CKD patients.