We thank Milovanova et al. 1 for their comments regarding our manuscript reporting the association of fibroblast growth factor 23 (FGF-23) with left ven- tricular (LV) diastolic dysfunction in hemodialysis patients. 2 Consistent with our findings, Milovanova et al. also demonstrated a correlation between FGF-23 levels and LV diastolic function in 51 patients with advanced chronic kidney disease (CKD), of whom 26 were treated with hemodialysis and 78% had an LV ejection fraction >50%. 1 However, they also measured Klotho, and observed that serum Klotho levels correlated with LV diastolic function as well. Whereas the association between higher FGF-23 levels and more severe LV diastolic dysfunction did not persist in multivariate analysis including Klotho as a covariate, the association between lower Klotho levels and more severe LV diastolic dysfunction persisted, despite adjustment for FGF-23.
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