Circulating α-klotho levels in CKD and relationship to progression

Hyoung Rae Kim, Bo Young Nam, Dong Wook Kim, Min Woong Kang, Jae Hyun Han, Mi Jung Lee, Dong Ho Shin, Fa Mee Doh, Hyang Mo Koo, Kwang Il Ko, Chan Ho Kim, Hyung Jung Oh, Tae Hyun Yoo, Shin Wook Kang, Dae Suk Han, Seung Hyeok Han

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143 Citations (Scopus)


Background: α-Klotho is reported to have protective effects against kidney injury, and its renal expression is decreased in many experimental models of kidney disease. However, circulating α-klotho levels in human chronic kidney disease (CKD) and the relationship to progression are unknown. Study Design: Post hoc analysis of a prospective cohort study. Setting & Participants: 243 of 301 participants from a CKD cohort at our institution between January 2006 and December 2011 were eligible for the study. Predictor: Baseline α-klotho levels. Outcomes: Primary outcome was the composite of doubling of baseline serum creatinine concentration, end-stage renal disease, or death. End-stage renal disease was defined as onset of treatment by renal replacement therapy. Measurements: Serum α-klotho and fibroblast growth factor 23 (FGF-23) were measured using enzyme-linked immunosorbent assay. Results: Lower serum α-klotho levels were associated with more severe CKD stage in the cross-sectional analysis of the baseline data (P for trend < 0.001). In the adjusted multivariable linear regression model, log(α-klotho) was associated independently with estimated glomerular filtration rate (β = 0.154; P = 0.001). Cox regression analysis showed that baseline α-klotho level independently predicted the composite outcome after adjustment for age, diabetes, blood pressure, estimated glomerular filtration rate, proteinuria, parathyroid hormone level, and FGF-23 level (HR per 10-pg/mL increase, 0.96; 95% CI, 0.94-0.98; P < 0.001). When patients were categorized into 2 groups according to baseline median α-klotho value, 43 (35.2%) patients with α-klotho levels ≤396.3 pg/mL reached the primary composite outcome compared with 19 (15.7%) with α-klotho levels >396.3 pg/mL (HR, 2.03; 95% CI, 1.07-3.85; P = 0.03). Limitations: Uncontrolled dietary phosphorus intake and use of frozen samples. Conclusions: This observational study showed that low circulating α-klotho levels were associated with adverse kidney disease outcome, suggesting that α-klotho is a novel biomarker for CKD progression. More data from larger prospective longitudinal studies are required to validate our findings.

Original languageEnglish
Pages (from-to)899-909
Number of pages11
JournalAmerican Journal of Kidney Diseases
Issue number6
Publication statusPublished - 2013 Jun

Bibliographical note

Funding Information:
Support: This work was supported by the National Research Foundation of Korea grant funded by the Korea government ( 2012R1A1A1002575 ); by the Brain Korea 21 Project for Medical Science, Yonsei University; and by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea ( A102065 ).

All Science Journal Classification (ASJC) codes

  • Nephrology


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