Alpha-klotho and peritoneal membrane status: A hypothesis generating study

Background: Long-term success of peritoneal dialysis relies on the integrity of the peritoneal membrane. This proof-of-concept study addressed the hypothesis that fibrosis is already present in the membrane at pre-dialysis and that the membrane status is related to the individual's uraemic fingerprint. Methods: A clinical-mechanistic, transversal, single-centre study was conducted. Pre-dialysis peritoneal biopsies were scored considering the submesothelial compact zone thickness (STM), vasculopathy and inflammation. We investigated if the membrane status could be inferred from a panel of proteins (alpha-Klotho, Galectin-3, FGF21, FGF23, Tweak, TNF alpha and hsPCR) in blood. Results: A total 58 incident patients aged 56 +/- 15 years old were included, 31% female, 55% hypertension, 29% diabetic and 24% obese. Person-to-person STM was found to be highly variable and 38% of patients were fibrosis positive. Both alpha-Klotho (Spearman r = -.7491, p < 0.001) and FGF21 (Spearman r = -.5102, p < 0.001) were negatively associated with STM. alpha-Klotho, but not FGF21, was able to discriminate fibrosis from nonfibrosis with/without inflammation and vasculopathy. PLS models identified alpha-Klotho as the protein most relevant for fibrosis. alpha-Klotho was independently associated with fibrosis of the peritoneal membrane (OR = .991 (.896-.997), p = 0.002). Conclusion: Before the start of dialysis in incident patients, some patients already present fibrosis of the peritoneal membrane and other patients do not. Our findings suggest that alpha-Klotho may be implicated in fibrosis of the peritoneal membrane.

Automated summary

This study found that some patients already have fibrosis of the peritoneal membrane before starting dialysis, while others do not. The results suggest that alpha-Klotho may be implicated in fibrosis of the peritoneal membrane.