---
title: "Klotho, FGF23, and Their Ratio as Predictors of Sepsis-Associated Acute Kidney Injury"
id: "pubmed-42853715"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42853715"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42853715/"
doi: "10.1159/mpp/adpag028"
published_at: "2026-10-09T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Klotho, FGF23, and Their Ratio as Predictors of Sepsis-Associated Acute Kidney Injury
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42853715
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42853715/)
- **DOI:** [10.1159/mpp/adpag028](https://doi.org/10.1159%2Fmpp%2Fadpag028)
- **Published At:** 2026-10-09T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective cohort study evaluated serum **Klotho**, **fibroblast growth factor 23 (FGF23)**, and the **Klotho/FGF23 ratio** for association with sepsis-associated acute kidney injury (SA-AKI) and short-term outcomes. - The study included 320 intensive care unit patients meeting Sepsis-3 criteria; SA-AKI was identified in 112 patients using KDIGO criteria. - Stored serum samples collected within 24 hours of ICU admission were assayed by enzyme-linked immunosorbent assay for Klotho and FGF23. - At admission, patients who developed SA-AKI had lower Klotho, higher FGF23, and a reduced Klotho/FGF23 ratio (all p < 0.001). - The **Klotho/FGF23 ratio** had the highest observed discrimination for SA-AKI with area under the curve 0.84 (95% CI 0.79–0.88). - After multivariable adjustment, the Klotho/FGF23 ratio remained independently associated with SA-AKI (adjusted odds ratio 2.25; 95% CI 1.46–3.53). - The ratio declined progressively with increasing KDIGO stage among affected patients. - Within the SA-AKI subgroup, a low Klotho/FGF23 ratio was associated with poorer short-term renal recovery at 3 months, longer ICU and hospital lengths of stay, higher in-hospital mortality, and greater progression to chronic kidney disease at 3 months after adjustment. - The authors conclude that the admission **Klotho/FGF23 ratio** was associated with SA-AKI, higher KDIGO stage, and adverse short-term outcomes and outperformed Klotho and FGF23 individually in discrimination. - Detailed methods, specific adjustment variables, and absolute values for biomarker concentrations were not reported in the PubMed abstract provided.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Clinical Significance of Klotho, Fibroblast Growth Factor 23, and their Ratio for Acute Kidney Injury in Sepsis Patients [Sumian Dou](https://pubmed.ncbi.nlm.nih.gov/?term=Dou+S&cauthor_id=42853715), [Yuchao Shen](https://pubmed.ncbi.nlm.nih.gov/?term=Shen+Y&cauthor_id=42853715), [Botao Zhao](https://pubmed.ncbi.nlm.nih.gov/?term=Zhao+B&cauthor_id=42853715), [Ling Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+L&cauthor_id=42853715), [Wei Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+W&cauthor_id=42853715), [Jing Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+J&cauthor_id=42853715), [Chunxue Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+C&cauthor_id=42853715), [Long Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+L&cauthor_id=42853715), [Zhanghai Sun](https://pubmed.ncbi.nlm.nih.gov/?term=Sun+Z&cauthor_id=42853715), [Ying Cui](https://pubmed.ncbi.nlm.nih.gov/?term=Cui+Y&cauthor_id=42853715) * PMID: **42853715** * DOI: [ 10.1159/mpp/adpag028 ](https://doi.org/10.1159/mpp/adpag028) Item in Clipboard # Clinical Significance of Klotho, Fibroblast Growth Factor 23, and their Ratio for Acute Kidney Injury in Sepsis Patients Sumian Dou et al. Med Princ Pract. 2026. Show details Display options Display options Format Abstract PubMed PMID Med Princ Pract Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Med+Princ+Pract%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Med+Princ+Pract%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42853715/) . 2026 Oct 9:1. doi: 10.1159/mpp/adpag028. Online ahead of print. ### Authors [Sumian Dou](https://pubmed.ncbi.nlm.nih.gov/?term=Dou+S&cauthor_id=42853715), [Yuchao Shen](https://pubmed.ncbi.nlm.nih.gov/?term=Shen+Y&cauthor_id=42853715), [Botao Zhao](https://pubmed.ncbi.nlm.nih.gov/?term=Zhao+B&cauthor_id=42853715), [Ling Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+L&cauthor_id=42853715), [Wei Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+W&cauthor_id=42853715), [Jing Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+J&cauthor_id=42853715), [Chunxue Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+C&cauthor_id=42853715), [Long Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+L&cauthor_id=42853715), [Zhanghai Sun](https://pubmed.ncbi.nlm.nih.gov/?term=Sun+Z&cauthor_id=42853715), [Ying Cui](https://pubmed.ncbi.nlm.nih.gov/?term=Cui+Y&cauthor_id=42853715) * PMID: **42853715** * DOI: [ 10.1159/mpp/adpag028 ](https://doi.org/10.1159/mpp/adpag028) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Objective:** The sepsis-associated acute kidney injury (SA-AKI) is common in patients with sepsis and associated with poor outcomes, yet serum creatinine and urine output have limited value for early assessment. We examined whether admission Klotho, fibroblast growth factor 23 (FGF23), and the Klotho/FGF23 ratio were associated with SA-AKI and short-term outcomes and compared their discriminative performance. **Methods:** We conducted a retrospective cohort study of 320 patients admitted to the intensive care unit (ICU) with Sepsis-3-defined sepsis. SA-AKI (n = 112) was retrospectively identified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Klotho and FGF23 were measured by enzyme-linked immunosorbent assay in stored serum samples collected within 24 h of ICU admission. Discrimination was assessed by receiver operating characteristic analysis, and adjusted associations were evaluated using multivariable logistic and linear regression. **Results:** Patients with SA-AKI had lower Klotho, higher FGF23, and a reduced Klotho/FGF23 ratio at admission (all p < 0.001). The ratio showed the highest area under the curve biomarkers for SA-AKI (0.84; 95% confidence interval 0.79 - 0.88) and remained associated with SA-AKI after multivariable adjustment (odds ratio 2.25; 95% confidence interval 1.46 - 3.53). The ratio decreased with increasing KDIGO stage. Among patients with SA-AKI, a low ratio remained associated with lower 3-month renal recovery, longer ICU and hospital stays, higher in-hospital mortality, and greater 3-month chronic kidney disease progression after adjustment. **Conclusion:** The admission Klotho/FGF23 ratio was associated with SA-AKI, higher KDIGO stage, and short-term outcomes and showed the highest observed discrimination among the three biomarkers. © The Author(s) 2026. Published by S. Karger AG. 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