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Kidney Week

Abstract: TH-PO1114

Low Soluble Klotho Levels Are Associated with Renal Function Decline in Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Shikida, Yasuto, Showa University Hospital, Tokyo, Japan
  • Mizobuchi, Masahide, Showa University Hospital, Tokyo, Japan
  • Yoshitake, Osamu, Showa university, Shinagawa, Japan
  • Kato, Tadashi, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan, Yokohama, Japan
  • Ogata, Hiroaki, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan, Yokohama, Japan
  • Koiwa, Fumihiko, Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
  • Akizawa, Tadao, Showa University Hospital, Tokyo, Japan
Background

Serum soluble klotho levels have been shown to be associated with renal function in pre-dialysis patients with chronic kidney disease. However, there are few reports regarding the association between soluble klotho levels and renal function in kidney transplant (KTx) recipients. Thus, we investigated the association of soluble klotho levels of the pre-KTx with renal function decline in living KTx recipients.

Methods

This is a retrospective, observational study of 41 living KTx recipients who received standard immunosuppressive therapy between 2002 and 2017 in our hospital. The serum soluble klotho levels were divided into 2 groups according to the median value: ≧ 456 pg/ml (High group, n=21), or < 456 pg/ml (Low group, n=20). Renal function decline was defined as a 30% or more decrease in estimate glomerular filtration rate (eGFR) compared with that of baseline within 3 months after KTx. A multivariable time-to-event analysis between the groups was performed.

Results

4.9% of the recipients received preemptive KTx. 75.6% and 19.5% of the recipients were treated with hemodialysis and peritoneal dialysis before KTx, respectively. Median dialysis vintage was 408 days (interquartile range, IQR :168-1132 days). Median follow-up period was 913 days (IQR: 318-2015 days). KTx recipients in the Low group showed a significant higher incidence of 30% decrease in eGFR than those in the High group (p=0.036). In multivariable Cox models adjusting for patient-age, donor-age, the presence of rejection, and the number of HLA mismatch, the low soluble Klotho levels remained to be associated with a higher risk of 30% decrease in eGFR (HR: 2.78, 95%CI: 1.02-8.26).

Conclusion

These results suggest that lower soluble klotho levels of the pre-KTx are associated with increased risk of renal function decline in KTx recipients. Maintenance of higher serum soluble klotho levels before KTx may be preferable for renal function preservation.