Fibroblast growth factor 23 (FGF-23) and its coreceptor, α-Klotho, are key factors in phosphate homeostasis, and their dysregulation is an essential link between osteodystrophy, left ventricular hypertrophy, atherosclerosis, systemic inflammation, and renal fibrosis observed in patients with ESKD (2). The gene discussed is KL; the disease is renal fibrosis.