α-Klotho is associated with cardiovascular and all-cause mortality in patients with stage 3b and 4 chronic kidney disease (CKD): a long-term prospective cohort study.

Autor: Milovanova LY; Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya st., Moscow, 119991, Russian Federation. Ludm.milovanova@gmail.com.; Department of Internal, Occupational Diseases and Rheumatology, Sechenov University, Moscow, Russian Federation. Ludm.milovanova@gmail.com., Nezhdanov KS; Lomonosov Moscow State University, Leninskie Gory, Moscow, 119991, Russian Federation.; Department of Internal Diseases, Lomonosov Moscow State University, Moscow, Russian Federation., Milovanova SY; Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya st., Moscow, 119991, Russian Federation.; Department of Internal, Occupational Diseases and Rheumatology, Sechenov University, Moscow, Russian Federation., Lebedeva MV; Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya st., Moscow, 119991, Russian Federation.; Department of Internal, Occupational Diseases and Rheumatology, Sechenov University, Moscow, Russian Federation., Beketov VD; Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya st., Moscow, 119991, Russian Federation.; Department of Internal, Occupational Diseases and Rheumatology, Sechenov University, Moscow, Russian Federation., Volkov AV; Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya st., Moscow, 119991, Russian Federation.; Department of Internal, Occupational Diseases and Rheumatology, Sechenov University, Moscow, Russian Federation., Kamyshova ES; Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya st., Moscow, 119991, Russian Federation.; Department of Internal, Occupational Diseases and Rheumatology, Sechenov University, Moscow, Russian Federation., Suvorov AY; Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya st., Moscow, 119991, Russian Federation.; Department of Internal, Occupational Diseases and Rheumatology, Sechenov University, Moscow, Russian Federation., Moiseev SV; Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya st., Moscow, 119991, Russian Federation.; Lomonosov Moscow State University, Leninskie Gory, Moscow, 119991, Russian Federation.; Sechenov University, Moscow, Russian Federation.; Department of Internal Medicine, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russian Federation.
Jazyk: angličtina
Zdroj: Journal of nephrology [J Nephrol] 2024 Sep 02. Date of Electronic Publication: 2024 Sep 02.
DOI: 10.1007/s40620-024-02069-5
Abstrakt: Background: α-Klotho deficiency may increase cardiovascular risks and worsen survival. We evaluated the association of α-Klotho with cardiovascular and all-cause mortality in pre-dialysis chronic kidney disease (CKD) patients.
Methods: In this prospective study, 75 non-diabetic CKD stage 3b-4 patients were followed-up for a median of 8 years. Primary and secondary outcomes were all-cause and cardiovascular mortality, respectively. Human soluble α-Klotho ELISA Assay (IBL-Takara 27,998-96Well), Human Fibroblast Growth Factor-23 ELISA Assay (intact FGF23, Merck Millipore MILLENZ FGF23-32 K), and Human Sclerostin ELISA kits (Biomedica, Vienna, BI-20492) were used to measure serum α-Klotho, FGF23 and sclerostin levels in the certified laboratory at the Sechenov University according to the manufacturers' protocols. All patients underwent echocardiography to evaluate left ventricular mass index (LVMI), left ventricular ejection fraction by Simpson method, and cardiac (valve) calcification score by a semi-quantitative point scale. Lateral abdominal radiography by Kauppila method was used to estimate calcification of the abdominal aorta. Cox multivariate regression and receiver-operating characteristic curve (ROC)-analysis were used to evaluate risk factors for death and their cut-off values.
Results: Primary and secondary endpoints were reached in 15 (20%) and 9 (12%) patients, respectively. Median α-Klotho levels in deceased and surviving patients were 344 and 484 pg/ml, respectively (p = 0.002). In a multivariate Cox regression model, baseline α-Klotho levels (HR 0.99, 95% CI 0.98-1.00, p = 0.023), aortic calcification (HR 1.18, 95% CI 1.02-1.36, p = 0.029) and left ventricular mass index (LVMI) (HR 1.04, 95% CI 1.00-1.08, p = 0.033) were associated with the primary endpoint, whereas α-Klotho (HR 0.99, 95% CI 0.98-1.00, p = 0.029), aortic calcification (HR 1.23, 95% CI 1.07-1.42, p = 0.003) and LVMI (HR 1.04, 95% CI 1.00-1.08, p = 0.021) were associated with the secondary endpoint. α-Klotho levels had the highest area under the curve (AUC) by ROC analysis, that is, 0.766 (95% CI 0.70-0.82) for the primary endpoint and 0.842 (95% CI 0.79-0.90) for the secondary endpoint with cut-off values of 412 pg/ml (HR 3.06, 95% CI 1.36-6.89, p = 0.007) and 368 pg/ml (HR 4.84, 95% CI 1.59-14.73, p = 0.005), respectively.
Conclusion: In pre-dialysis CKD patients, α-Klotho levels are associated with all-cause and cardiovascular mortality and may be considered an early prognostic marker.
(© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)
Databáze: MEDLINE
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