Decreased plasma α-Klotho predict progression of nephropathy with type 2 diabetic patients

J Diabetes Complications. 2016 Jul;30(5):887-92. doi: 10.1016/j.jdiacomp.2016.03.006. Epub 2016 Mar 11.


Aim: The potential role of soluble α-klotho in diabetic kidney disease has not yet been evaluated. The aim of this study was to evaluate the association of plasma and/or urine α-klotho with the progression of type 2 diabetic nephropathy.

Methods: The baseline values of plasma and urine α-klotho were measured in 147 patients with type 2 diabetes mellitus with an estimated glomerular filtration rate (eGFR) of ≥60mL/min/1.73m(2). In this prospective observational study, a total of 109 type 2 diabetic patients were followed up for 34months (8-50 months).

Results: Plasma α-klotho, but not urine α-klotho, was negatively correlated with the decline of eGFR (r=-0.304, P=0.001; r=0.042, P=0.068, respectively). After adjusting for several clinical parameters, baseline eGFR and urine ACR, plasma α-klotho was significantly associated with the decline of eGFR (r=-0.219, P=0.008). In the normoalbuminuria group (n=63), the plasma α-klotho remained significantly associated with a decline in eGFR (r=0.324, P=0.004) in the final model.

Conclusions: It is suggested that plasma α-klotho may be an early biomarker for predicting renal impairment in type 2 diabetic patients. The disappearance of a compensatory increase of plasma α-klotho might be a predictive marker for the progression of type 2 diabetic nephropathy.

Keywords: Albuminuria; Chronic kidney disease; Diabetic nephropathy; Type 2 diabetes mellitus; α-Klotho.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / complications
  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / urine
  • Adult
  • Aged
  • Albuminuria / etiology
  • Biomarkers / blood
  • Biomarkers / urine
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Nephropathies / blood*
  • Diabetic Nephropathies / physiopathology
  • Diabetic Nephropathies / urine
  • Disease Progression
  • Down-Regulation*
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Glucuronidase / blood*
  • Glucuronidase / urine
  • Humans
  • Kidney / physiopathology*
  • Klotho Proteins
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Insufficiency / blood*
  • Renal Insufficiency / complications
  • Renal Insufficiency / physiopathology
  • Renal Insufficiency / urine
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / physiopathology
  • Renal Insufficiency, Chronic / urine
  • Severity of Illness Index


  • Biomarkers
  • Glucuronidase
  • Klotho Proteins