Dr Makoto Kuro-o is a Professor of Anti-ageing Medicine at the Center for Molecular Medicine at Jichi Medical University, Japan. He and his team are working to understand the molecular mechanisms by which endocrine fibroblast growth factors (FGFs) ? which comprise FGF19, FGF21 and FGF23 and control a variety of physiological processes ? and Klotho family proteins regulate metabolism and ageing. Endocrine FGFs and Klotho family proteins are inextricably linked, with Klotho family proteins functioning as receptors for endocrine FGFs and playing an important role in the regulation of their activity.The researchers hope their observations on the pathogenesis of CKD will lead to the development of novel diagnostic markers and therapeutic targets for the disease. Revisiting observations about the pathogenesis of CKD using new knowledge rewarding the FGF23?Klotho endocrine system has led to new hypotheses and new paradigms for the diagnosis and treatment of patients with CKD.