Tanshinone IIA elevates serum soluble klotho levels and decreases cardiovascular events in patients on maintenance hemodialysis: a prospective before-after study.

Abstract

Cardiovascular disease (CVD) is the most common adverse event of maintenance hemodialysis (MHD), in which serum soluble klotho plays a vital role. Tanshinone IIA (tan) has been used to protect the cardiovascular system for hundreds of years. This study was performed to investigate the effects of tan on klotho level and cardiovascular events of MHD patients. Totally 112 patients were enrolled in this study, and their demographic, clinical, and laboratory characteristics were collected at admission. Serum soluble klotho, carotid intima-media thickness (CIMT), and abdominal aorta calcification (AAC) level were measured to determine their relationship. Seventy-one patients were given sodium tan sulfonate injection according to their willingness, while 41 patients were not given any specific treatment. The endpoint events were recorded, including cardiovascular mortality, nonfatal cardiovascular events, and all-cause mortality. All patients were divided into two groups on whether the level of serum soluble klotho was more than medium or not. CIMT and AAC grade showed significant differences between 2 groups (group of low level of klotho versus group of high level of klotho, CIMT: 1.03±0.22 vs. 0.85±0.20 mm, P<0.001; AAC grade: 5.04±3.93 vs. 1.69±2.30 points, P<0.001). All patients were followed up for at least one year. The results revealed that using tan improved the level of serum soluble klotho (490.23±153.97 pg/mL after using tan versus 444.49±143.32 pg/mL before using tan, P=0.042). Kaplan-Meier curves showed that cardiovascular event-free survival was significantly higher in patients given tan (P=0.040) compared with patients not given tan. Tan effectively increases the level of serum soluble klotho and further reduces the incidence of cardiovascular events in MHD patients.