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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 
 American Journal of Kidney Diseases, Vol.61(6) : 899-909, 2013 
Journal Title
 American Journal of Kidney Diseases 
Issue Date
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
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원)
Yonsei Authors
강민웅(Kang, Min Woong)
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
고광일(Ko, Kwang Il)
구향모(Koo, Hyang Mo)
김동욱(Kim, Dong Wook)
김찬호(Kim, Chan Ho)
김형래(Kim, Hyoung Rae)
남보영(Nam, Bo Young)
도화미(Doh, Fa Mee)
신동호(Shin, Dong Ho)
오형중(Oh, Hyung Jung)
유태현(Yoo, Tae Hyun)
이미정(Lee, Mi Jung)
한대석(Han, Dae Suk)
한승혁(Han, Seung Hyeok)
한재현(Han, Jae Hyun)
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