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

Aim: The potential role of soluble alpha-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 alpha-klotho with the progression of type 2 diabetic nephropathy. Methods: The baseline values of plasma and urine alpha-klotho were measured in 147 patients with type 2 diabetes mellitus with an estimated glomerular filtration rate (eGFR) of >= 60 mL/min/1.73 m(2). In this prospective observational study, a total of 109 type 2 diabetic patients were followed up for 34 months (8-50 months). Results: Plasma alpha-klotho, but not urine alpha-klotho, was negatively correlated with the decline of eGFR (r = -0304, P = 0.001; r = 0.042, P = 0.068, respectively). After adjusting for several clinical parameters, baseline eGFR and urine ACR, plasma alpha-klotho was significantly associated with the decline of eGFR (r = -0.219, P = 0.008). In the normoalbuminuria group (n = 63), the plasma alpha-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 alpha-klotho may be an early biomarker for predicting renal impairment in type 2 diabetic patients. The disappearance of a compensatory increase of plasma alpha-klotho might be a predictive marker for the progression of type 2 diabetic nephropathy. (C) 2016 Elsevier Inc. All rights reserved.