Low serum Klotho level as a predictor of calcification of the heart and blood vessels in patients with CKD stages 2–5D

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Abstract


 

Cardiovascular calcification (CVC) makes a significant contribution to the manifestation of cardiovascular complications in patients with chronic kidney disease. Early CVC markers are currently being actively studied to optimize cardio-renoprotective strategies. We performed a prospective comparative analysis of the following factors: FGF-23, a-Klotho, sclecrostin, phosphate, parathyroid hormone, the estimated glomerular filtration rate (eGFR), central systolic pressure as an independent determinant of CVC.

Materials and methods. The study included 131 patients with chronic kidney disease 2–5D st. Serum levels of FGF-23, Klotho, and sclerostin were evaluated using the ELISA method. Vascular augmentation (stiffness) indices, central arterial pressure (using the SphygmoCor device), calcification of heart valves and the degree of aortic calcification (aortic radiography) were also investigated. The observation period was 2 years.

Results. According to the Spearman correlation analysis, the percent of calcification increase and the change in Klotho level are most related. According to ROC analysis, a decrease in serum levels of Klotho by 50 units or more is a significant predictor of an increase in aortic calcification of 50% or more with a sensitivity of 86% and a specificity of 77%. Using logistic regression analysis, it was found that a serum Klotho level <632 pg/L predicts an eGFR below a median level of 48 ml/min/1.73 m2 with a sensitivity of 85.5% and a specificity of 78.5%. Wherein OR 17.477 (CI 95% 8.046–37.962; p<0.001).

Conclusion. The factor most associated with CVC is Klotho. Decreased serum level of Klotho is a predictor of aortic calcification. In addition, the initial serum level of Klotho is a predictor of eGFR after 2 years.


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About the authors

Ludmila Yu. Milovanova

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-5599-0350

Russian Federation, Moscow

д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии

Lidia V. Lysenko (Kozlovskaya)

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-1166-7308

Russian Federation, Moscow

д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии

Svetlana Yu. Milovanova

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-2687-6161

Russian Federation, Moscow

д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии.

Marina V. Taranova

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-7363-6195

Russian Federation, Moscow

к.м.н., доц. каф. внутренних, профессиональных болезней и ревматологии

Vasiliy V. Kozlov

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-2389-3820

Russian Federation, Moscow

доц. каф. общественного здоровья и организации здравоохранения

Vladimir A. Reshetnikov

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-2987-7995

Russian Federation, Moscow

д.м.н., проф. каф. общественного здоровья и организации здравоохранения

Marina V. Lebedeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-5923-1837

Russian Federation, Moscow

к.м.н., доц. каф. внутренних, профессиональных болезней и ревматологии

Tatyana V. Androsova

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-9951-126X

Russian Federation, Moscow

к.м.н., доц. каф. внутренних, профессиональных болезней и ревматологии

Daria O. Zubacheva

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0001-8020-7041

Russian Federation, Moscow

ординатор 1-го года обучения каф. внутренних, профессиональных болезней и ревматологии

Natalia V. Chebotareva

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0003-2128-8560

Russian Federation, Moscow

д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии

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