Buiten Maurits S, de Bie Mihály K, Bouma-de Krijger Annet, van Dam Bastiaan, Dekker Friedo W, Jukema J Wouter, Rabelink Ton J, Rotmans Joris I
Department of Nephrology, Leiden University Medical Center, P O Box 9600, 2300 RC Leiden, The Netherlands.
BMC Nephrol. 2014 Dec 11;15:197. doi: 10.1186/1471-2369-15-197.
Dialysis patients suffer from a high burden of cardiovascular disease (CVD). Partly this is due to progressive deterioration of calcium-phosphate homeostasis. Previous studies suggested that besides FGF-23, low levels of Klotho, a protein linked to aging, might constitute a key factor in this detrimental relationship. The purpose of the present study was to determine the relationship between serum Klotho (sKlotho) and the presence of CVD in dialysis patients.
Plasma levels of sKlotho were measured in a cohort of dialysis patients and related to left ventricular (LV) dysfunction (defined as a LV ejection fraction<45%) and LV mass using echocardiography. Coronary artery disease (CAD) and calcification score were assessed using computed tomography angiography. Abdominal aortic calcification score (AACscore) was measured by abdominal X-ray.
We included 127 dialysis patients, 67±7 years old, 76% male, 67% on hemodialysis, median sKlotho 460 pg/mL (25th-75th percentile 350-620 pg/mL). Patients with a low sKlotho (<460 pg/mL) showed significantly more CAD (81% versus 61%; p=0.02) and LV dysfunction (19% versus 3%; p<0.01). However, after adjusting for confounders, sKlotho was not independently associated with the presence of CVD or the AACscore.
In the present cohort of dialysis patients, sKlotho was not independently associated with CVD. However, patients with a low sKlotho level (<460 pg/mL) did show CAD and LV dysfunction more frequently. Therefore, while sKlotho might be a marker for CVD in dialysis patients, the current data does not support a direct cardioprotective effect of sKlotho.
透析患者承受着心血管疾病（CVD）的沉重负担。部分原因是钙磷稳态的逐渐恶化。先前的研究表明，除了成纤维细胞生长因子23（FGF - 23）外，与衰老相关的蛋白质α-klotho水平较低可能是这种有害关系的关键因素。本研究的目的是确定透析患者血清α-klotho（sKlotho）与CVD存在之间的关系。
在一组透析患者中测量sKlotho的血浆水平，并通过超声心动图将其与左心室（LV）功能障碍（定义为左心室射血分数<45%）和左心室质量相关联。使用计算机断层扫描血管造影评估冠状动脉疾病（CAD）和钙化评分。通过腹部X线测量腹主动脉钙化评分（AACscore）。
我们纳入了127例透析患者，年龄67±7岁，男性占76%，67%接受血液透析，sKlotho中位数为460 pg/mL（第25 - 75百分位数为350 - 620 pg/mL）。sKlotho水平低（<460 pg/mL）的患者CAD发生率显著更高（81%对61%；p = 0.02），左心室功能障碍发生率也更高（19%对3%；p<0.01）。然而，在调整混杂因素后，sKlotho与CVD的存在或AACscore无独立相关性。
在本组透析患者中，sKlotho与CVD无独立相关性。然而，sKlotho水平低（<460 pg/mL）的患者CAD和左心室功能障碍的发生率确实更高。因此，虽然sKlotho可能是透析患者CVD的一个标志物，但目前的数据不支持sKlotho具有直接的心脏保护作用。
