Indian Chronic Kidney Disease Research Articles

Correlates of Chronic Kidney Disease in India

Chronic kidney disease (CKD) is one of the major non-communicable diseases in India, yet there is a lack of nationally representative studies. The present study aimed to correlate certain demographic factors like tobacco use, alcohol use, the use of clean fuel, economic condition, obesity, and diabetes with CKD burden. National Family Health Survey 4 (2015–2016), Global Adult Tobacco Survey 2: India 2016–2017, and India: Health of the Nation’s States were used as data sources. Spearman correlation coefficient, scatter plot, and multivariate linear regression were used for analysis, considering state as a unit. Obesity and diabetes were significantly correlated with CKD burden (r = 0.452, p = 0.012 and r = 0.789, p = 0.000, respectively). Even after multivariate regression, they were found significant predictors for CKD burden. For reducing the burden of CKD, emphasis should be given to early diagnosis and management of diabetes and lifestyle modification.

Metal mixtures and kidney function: An application of machine learning to NHANES data

BackgroundExposure to heavy metals may increase risk of kidney disease, but most studies have examined individual metals or two-way interactions. There is increasing recognition of the importance of studying exposure to metal mixtures and health outcomes. ObjectivesWe used Bayesian kernel machine regression (BKMR) to examine associations between a mixture of four heavy metals and indicators of kidney function. MethodsWe used NHANES 2015-16 data on 1435 adults aged 40 and over to study cross-sectional associations between blood levels of four heavy metals (Co, Cr, Hg and Pb) and kidney function. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and by albumin to creatinine ratio (ACR), measured continuously and dichotomized into indicators of chronic kidney disease (CKD) and albuminuria, respectively. BKMR tested for non-linearity in the exposure-specific responses to evaluate dose-response relationships between mixtures and outcomes and possible interaction effects among exposures. Interactions among continuous outcomes were identified using the NLinteraction package in R. ResultsA higher metals mixture was significantly associated with all four measures of kidney function in dose-response patterns. Pb had the strongest association with eGFR, albuminuria and ACR, and the second strongest association with CKD. We also observed an interaction between Pb and Co for eGFR and an interaction between Pb and Cd for ACR. ConclusionsExposure to a co-occurring heavy metals mixture was associated with indicators of poor kidney function. Within this mixture, Pb, Co and Cd considered singly and jointly made the greatest contributions to the observed effects. Future prospective study is needed to confirm the association between metal mixtures and kidney function.

Urine S-Adenosylmethionine are Related to Degree of Renal Insufficiency in Patients with Chronic Kidney Disease.

To determine whether urine S-adenosylmethionine (SAM) might be an indicator of chronic kidney disease (CKD). We investigated urine levels of SAM and related metabolites (S-adenosylhomocysteine and homocysteine cysteine) in 62 patients (average age, 65.9 years) with CKD (stages II-V). Patients with stages III-V CKD stages have significantly decreased urine levels and SAM/S-adenosylhomocysteine ratio and also cysteine/homocysteine ratio in blood plasma (P <.05), compared with patients with stage II CKD. Urine SAM levels allowed us to distinguish patients with mildly decreased kidney function from those with moderate to severe renal impairment (AUC, 0.791; sensitivity, 85%; specificity, 78.6%). Our study results demonstrate that urine SAM is a potent biomarker for monitoring renal function decline at early CKD stages. Urine SAM testing confers an additional advantage to healthcare professionals in that it is noninvasive.

Proteinurie z pohledu internisty

A basal level of proteinuria is about 30-100 mg/day, the upper limit of basal proteinuria does not exceed 150 mg/day which is considered non-pathology. Albumin accounts approximately 15 % of basal protein in the urine, other plasma proteins (immunoglobulins, &#946;-2 microglobulin, Tamm-Horsfall mucoprotein) comprise the remaining 85 % of total quantity non-pathology proteinuria. Persistent proteinuria present for more than three months already meets the definition of chronic kidney disease independently of the stage of the estimated glomerular filtration rate. Patients are classified as A1-A3 based on the level of albuminuria. Examination of the albumin in the urine is one of the single sensitive indicators of chronic kidney disease. Proteinuria is an independent risk factor for cardiovascular disease, overall mortality and end stage renal failure both in general population and in population with chronic kidney disease. Presence of the urinary protein is associated with a higher mortality rate in critically ill patients. The degree of proteinuria after kidney transplantation predicts graft and patient survival in this population. Pharmacological and non-pharmacological treatments that attenuate proteinuria have been associated with better prognosis of kidney disease.

Nonmedical Factors and Health-Related Quality of Life in CKD in India.

Patient-reported outcomes have gained prominence in the management of chronic noncommunicable diseases. Measurement of health-related quality of life is being increasingly incorporated into medical decision making and health care delivery processes. The Indian Chronic Kidney Disease Study is a prospective cohort of participants with mild to moderate CKD. Baseline health-related quality of life scores, determined by the standardized Kidney Disease Quality of Life 36 item instrument, are presented for the inception cohort (n=2919). Scores are presented on five subscales: mental component summary, physical component summary, burden, effect of kidney disease, and symptom and problems; each is scored 0-100. The associations of socioeconomic and clinical parameters with the five subscale scores and lower quality of life (defined as subscale score <1 SD of the sample mean) were examined. The main socioeconomic factors studied were sex, education, occupation, and income. The key medical factors studied were age, eGFR, diabetes, hypertension, and albuminuria. The mean (SD) subscale scores were physical component summary score, 43±9; mental component summary score, 48±10; burden, 61±33; effects, 87±13; and symptoms, 90±20. Among the socioeconomic variables, women, lower education, and lower income were negatively associated with reduced scores across all subscales. For instance, the respective β-coefficients (SD) for association with the physical component summary subscale were -2.6 (-3.4 to -1.8), -1.5 (-2.2 to -0.7), and -1.6 (-2.7 to -0.5). Medical factors had inconsistent or no association with subscale scores. The quality of life scores also displayed regional variations. In this first of its kind analysis from India, predominantly socioeconomic factors were associated with quality of life scores in patients with CKD.

Prevalence of Chronic Kidney Disease in Cuttack District of Odisha, India

Chronic kidney disease is one of the major health challenges in India. Cuttack district of the Odisha state of India is regarded as a hotspot for chronic kidney disease (CKD). However, there is limited information on true prevalence. This study estimates the prevalence of CKD in the Narsinghpur block of Cuttack district, Odisha. A cross-sectional study was conducted among population members aged 20–60 years. Using a multi-stage cluster sampling. 24 villages were randomly selected for mass screening for CKD. Blood samples were collected and glomerulus filtration rates were calculated. It was found that among the 2978 people screened, 14.3% were diagnosed with CKD and 10.8% were diagnosed with CKD without either diabetes or hypertension. In one-third of the sampled villages, about 20% population was diagnosed with CKD. The prevalence was higher among males (57%), in the population below 50 years of age (54%), lower socioeconomic groups (70%), and agricultural occupational groups (48%). Groundwater tube wells (49%) and wells (41%) were the main drinking water sources for CKD patients. This study highlights the need for detection of unknown etiologies of CKD and public health interventions for the prevention of CKD in India.

Correlation of serum soluble Klotho with fibroblast growth factor 23 levels in chronic kidney disease patients; a single centre study

Introduction: Klotho is a single-pass transmembrane protein with a long extracellular domain and short cytoplasmic tail that appears to modulate aging. Objectives: This cross-sectional investigation was conducted at a tertiary care centre to find the possible correlation of serum Klotho with various biochemical parameters in Indian chronic kidney disease (CKD) patients. Patients and Methods: The study was conducted in 80 CKD patients (58 males, 22 females). Mean age was 54.21 ± 14.08 years (25-90 years). Participants included 55 CKD- hemodialysis (HD), 10 CKD- peritoneal dialysis (PD) and 15 CKD-non-dialysis (ND) patients. Results: Serum Klotho (sKlotho) in CKD-HD patients ranged from 0 to 374.36 ng/mL with a mean of 13.76±4.3 ng/mL (median: 0.0174 ng/mL). In PD patients, sKlotho ranged from 0 to 374.36 ng/ mL with a mean of 37.58 ± 6.56 ng/mL (median of 0.0087 ng/mL). In ND population, sKlotho ranged from 0 to 7.01 ng/mL, with a mean of 0.73 ± 0.01 ng/mL (median of 0.1687ng/mL). In CKDHD and CKD-PD patients, sKlotho was positively correlated with the fibroblast growth factor 23 (pg/mL) (P&lt;0.001). Conclusion: Serum Klotho levels show significant positive correlation with FGF23 levels in HD and PD patients. The findings of the study indicate that high Klotho and fibroblast growth factor 23 levels may be associated with worse outcomes in chronic renal failure patients.

SUN-261 The Indian Chronic Kidney Disease cohort study: Baseline characteristics and correlates of renal function

Chronic kidney disease (CKD) has emerged as an important public health problem in India. The burden of disease and its risk factors are expected to rise exponentially. Defining the correct epidemiology of disease is the first step in approach to address disease outcomes. The Indian Chronic Kidney Disease (ICKD) study aims to define the course, progression and risk factors for disease complications in patients with CKD in India. The ICKD study is first of its kind, and the largest ongoing, nationwide, multi-centric prospective observational cohort study of CKD subjects in India, currently enrolling patients across eleven centers representing different geographic regions of India. Inclusion criteria include age between 18-70 years and CKD-EPI eGFR of 30-60 ml/min/1.73m2 or eGFR of >60 ml/min/1.73m2 with proteinuria and stable clinical course for at least 3 months. Organ transplant recipients, those with malignancy for last 2 years, non-Indian ethnicity, pregnancy in case of females, on immunosuppressive therapy, life expectancy <1 year and those with poor functional status are excluded. Demographic details, history related to kidney diseases and their risk factors, cardiovascular disease (CVD) and other co-morbidities are recorded periodically. Blood and urine samples are being collected at baseline and annually. We analyzed the baseline data of 2930 subjects enrolled between April 2018- 30 Sep 2018. The mean age of the cohort was 50.0±12.0 years and majority were males (69.9%). About 72% had hypertension, 34% were diabetic and 14.4 % had self-reported CVD. A total of 61%, 27% and 12% subjects had baseline eGFR >30-45, >45-60 and >60 ml/min/1.73m2, respectively. A total of 26% were uneducated, 66% were rural residents, 38% were vegetarian, 33% were smoker, and 44 % reported occupational exposure to sand, dust, chemicals, animals or working barefoot in fields. Approximately 7% had history of AKI, and 24% had used alternative medicines. Over 42% had BMI >25 kg/m2, whereas it was <18 kg/m2 in 6%. Older age, female gender, rural residence, lower income and education level, smoking, self-reported CVD, hypertension, diabetes and history of AKI were associated with lower eGFR (p<0.01). Exercising more than 30 min 5 times per week was associated with better eGFR (p<0.001). The ICKD study provides the first comprehensive description of early to moderate stage CKD in India, and a platform to study clinical, laboratory as well as socioeconomic determinants of prognostic factors. Lower socioeconomic status and educational level, apart from other well-known risk factors of CKD, were also associated with lower level of eGFR, whereas increased physical activity with better eGFR. Prospective follow-up will show if these correlates can determine the risk of progression of CKD and its complications.

SAT-251 DIFFERENCES IN PATIENTS BETWEEN CKD – CAUSE UNKNOWN AND THOSE WITH KNOWN CAUSES OF CKD: A COMPARISON FROM THE INDIAN CHRONIC KIDNEY DISEASE COHORT

The cause of chronic kidney disease (CKD) cannot be ascertained in a substantial proportion of patients in developing countries. Whether there is a systematic difference between the characteristics of these patients and those with known causes of CKD is not known. We present differences in the baseline profile of subjects with CKD-cause unknown (CKD-CU) versus those with known causes of CKD who are enrolled in the ongoing, multicentric Indian Chronic Kidney Disease (ICKD) study in India. The ICKD study is an ongoing, nationwide, prospective cohort study of subjects with early stage CKD (stage G3 or proteinuria with stage G1-2) at 11 centres across India. CKD-CU was defined as CKD without any identifiable clinical cause for CKD in the absence of any structural abnormality. Baseline demographic and investigational characteristics between those with CKD-CU versus known causes of CKD were compared by univariate analysis. Out of 2930 subjects enrolled in the ICKD study till September 2018, 731 (25%) were assigned a diagnosis of CKD-CU. Edema, hypertension and proteinuria were present in 10.7%, 60.7% and 41.9% of those with CKD-CU, respectively and were significantly less common in this group (p=0.002 for edema, p<0.001 for both hypertension and proteinuria). Subjects in CKD-CU group were significantly more likely to be older, have a shorter duration of kidney disease, poor educational status, rural residence, lower monthly earnings, farming or unskilled occupations and occupational exposure to sand, dust, fields or animals (p<0.001 for each). CKD-CU group were significantly less likely to have family history of kidney disease (p=0.003), history of alternative drug use (p<0.001) and history of AKI (p<0.001). Amongst investigations, CKD-CU group had significantly higher serum creatinine (p<0.001), uric acid (p=0.012), alkaline phosphatase (p=0.001), total protein (p=0.002) and albumin (p=0.02) but lower serum calcium levels (p=0.012). No differences were observed in gender distribution, dietary (vegetarian) status or self-reported cardiovascular disease. The cause of CKD cannot be determined in a quarter of CKD patients presenting to hospitals. Most of these patients come from rural or poorer socio-economic classes, are less educated and more likely to have potential occupational exposure. These factors need detailed exploration as risk factors.

SUN-289 Association of Ankle brachial index with renal function in Indian Chronic Kidney Disease (ICKD) cohort

Patients with chronic kidney disease (CKD) experience higher rates of cardiovascular disease (CVD) events and mortality. The risk of peripheral arterial disease (PAD), as measured by ankle-brachial index (ABI) is also increased in CKD. The prevalence of reduced glomerular filtration rate (eGFR) and a low ABI increase with aging. In this study, we assessed the association of biochemical parameters, eGFR with ABI in ICKD cohort.

SAT-248 SEX-DIFFERENCE IN INDIAN PATIENTS WITH CKD – FINDINGS FROM THE INDIAN CHRONIC KIDNEY DISEASE STUDY

The Indian Chronic Kidney Disease (ICKD) study is nationwide multicentric study to assess the progression and risk factors for disease complications in patients with CKD in India. We present sex-disaggregated baseline analysis of the ICKD cohort.

SAT-270 Results from the Chronic Kidney Disease Observational Database (CKDOD), India

Protein restricted diets (PRD) with or without ketoanalogue (KA) supplementation are an established treatment option in chronic kidney disease (CKD). Although their efficacy for slowing down decline of CKD has been shown in randomized controlled trials, implementation to clinical practice has not been investigated in detail in developing countries like India. The aim of this study was to examine utilization and effectiveness of PRD with or without KA supplementation in a real world setting. This observational study was a subcohort of eight Indian centers that participated in the CKDOD study (Shah et al. BMC Nephrol 2015;16:215). Data from routine care were documented between Jun 2010 and Dec 2017. Dietary patterns were analyzed in their relationship with progression of CKD assessed by eGFR decline over time using a mixed effects regression model. 1383 patients were enrolled. The most common dietary interventions were low protein diet (LPD, 0.6-0.8 g/kg) with or without KA supplementation (n = 412, 42%) and no PRD (n = 576, 58%). These patients (LPD or no PRD) were on average 56+/-14 years old (median 58 [47; 66]). 66% were male, 34% female. Most of them were in CKD stage 4 (339, 34%) and 5 (265, 27%). Their main underlying causes of CKD were diabetes mellitus (353, 36%) and hypertension (473, 48%). 54 LPD patients received KA supplementation at enrollment. Figure 1 shows the distribution of dietary protocols stratified by CKD stages (n per stage: 1:10, 2:22, 3A:85, 3B:225, 4:339, 5:265).eGFR changeView Large Image Figure ViewerDownload Hi-res image Download (PPT) The most common PRD in this selected cohort of Indian CKD patients was LPD. LPD was supplemented with KA for some but not all patients in later stages of CKD. Analysis of eGFR decline suggests that a potential beneficial effect of a KA-supplemented LPD might be applicable to routine care in India.

Multilevel qualification of blood gas analysers analytical performance: Evaluation of a set of 22 ABL90 Flex Plus analyzers

Chronic kidney disease (CKD) is a public health problem, which has a prevalence of 17.2% in India. As kidney function decreases, there is a gradual deterioration in the regulation of bone mineral homeostasis. Vitamin D is recognized as the central player in the maintenance of bone health in CKD. Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines suggest that vitamin D supplementation should be given to all CKD patients with serum 25-hydroxy vitaminD (25(OH)D) level < 30 ng/mL. Hence we undertook this study to evaluate the vitamin D status in South Indian patients with CKD.Fifty-nine non-dialysis CKD patients of stage 3 and 4 were recruited and screened for 25(OH)D deficiency. Circulating levels of 25(OH)D were measured using chemiluminescence immunoassay. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology (CKD-EPI) equation. Serum calcium, phosphorous, creatinine and alkaline phosphatase levels were measured spectrophotometrically by an autoanalyzer.Contrary to published literature, 75% of South Indian CKD patients had normal 25(OH)D (≥30 ng/mL), 15% of them had insufficient (20–29 ng/mL) and 10% had 25(OH)D deficiency (<20 ng/mL). Alkaline phosphatase levels were found to be increased in only 20% of cases. Calcium1 levels were normal in all CKD cases and hyperphosphatemia was observed in 5% of CKD patients.We found that most of our CKD patients (75%) had normal vitamin D levels. This paradoxical finding could be explained by the fact that most of them gave a history of intake of vitamin D and calcium supplements, as advised by their doctors before coming to our institute. Hence we conclude that before prescribing vitamin D or calcium supplements to CKD patients, their 25(OH)D status should be ascertained to prevent hypervitaminosis D and its complications.

Identification of PKD1 and PKD2 gene variants in a cohort of 125 Asian Indian patients of ADPKD

Autosomal Dominant Polycystic Kidney Disease (ADPKD) accounts for 2.6% of the patients with chronic kidney disease in India. ADPKD is caused by pathogenic variants in either PKD1 or PKD2 gene. There is no comprehensive genetic data from Indian subcontinent. We aimed to identify the pathogenic variants in the heterogeneous Indian population. PKD1 and PKD2 variants were identified by direct gene sequencing and/or multiplex ligation-dependent probe amplification (MLPA) in 125 unrelated patients of ADPKD. The pathogenic potential of the variants was evaluated computationally and were classified according to ACMG guidelines. Overall 300 variants were observed in PKD1 and PKD2 genes, of which 141 (47%) have been reported previously as benign. The remaining 159 variants were categorized into different classes based on their pathogenicity. Pathogenic variants were observed in 105 (84%) of 125 patients, of which 99 (94.3%) were linked to PKD1 gene and 6 (6.1%) to PKD2 gene. Of 159 variants, 97 were novel variants, of which 43 (44.33%) were pathogenic, and 10 (10.31%) were of uncertain significance. Our data demonstrate the diverse genotypic makeup of single gene disorders in India as compared to the West. These data would be valuable in counseling and further identification of probable donors among the relatives of patients with ADPKD.

Chronic Kidney Disease (CKD) in Patients Living with HIV under Antiretroviral Treatment: Prevalence and Risk Factors

CKD is one of the major complications when infected by HIV. The surveillance of CKD indicators and control of its determinants in the HIV-infected population in our African communities is essential. This was a descriptive and analytical cross-sectional study of people living with HIV received at the Ambulatory Treatment Center (ATC) at Infectious Diseases department of Sylvanus Olympio University Hospital (CHU-SO). The study period was 6 months—from January 1, 2018 to June 30, 2018—CKD was defined by a clearance below 60 ml/min/1.73 m2 for at least 3 months. A total of 117 patients were enrolled during the study period. The average age of patients for trial treatment was between 9.49 and 42.0 7 years. The duration of follow-up for antiretroviral treatment was ±3.22 to ±5.64 years. The female gender was predominant (70.09%) with a sex ratio (M/F) of 0.43. Most of people living with HIV were mostly classified at clinical stage 2 (31.03%) and 3 (31.90%) of WHO at initiation of HAART. The main CD4 rate was 223.30 ± 143.764 at initiation of HAART and 462.58 ± 202.723 at the time of the study. The majority of patients were placed in a fixed combination of Tenofovir/Lamivudine/Efavirenz in a proportion of 81.20% cases. CKD was found in 13 patients—that is 11.11% of patients. Univariate analysis shows that age greater than 45 years plus (p = 0.017) and pathological proteinuria (p = 0.021) were associated with CKD. In multivariate analysis, only ages (p = 0.045) and pathological proteinuria (p = 0.035) were significantly associated with CKD. The prevalence of CKD in HIV-infected patients is significant in Togo. The occurrence of proteinuria is linked to the delay in taking antiretroviral therapy.

The development of a near infrared inulin optical probe for measuring glomerular filtration rate

The polysaccharide, inulin, is considered the clinical gold standard for measuring glomerular filtration rate (GFR), an assessment of kidney filtering capacity and renal function, and therefore, is a prognostic indicator of chronic kidney disease (CKD). The classic method of measuring GFR is laborious, tedious and invasive. Therefore, estimated GFR (eGFR) has become the favoured measurement, but unfortunately suffers in its accuracy. Here, we describe the development of a near infrared dye-labeled inulin, Cy7.5-inulin conjugate, for use as an optical probe to accurately and non-invasively measure GFR in patients by transcutaneous pulse dye densitometer (TPDD). We have characterized the modifications made to inulin and the dye-polysaccharide conjugate by a number of analytical techniques and demonstrated that it is stable under experimental in vivo conditions. To this end, the probe has been successfully used in a pig model to accurately measure GFR non-invasively.

Liver stiffness assessed by transient elastography as a potential indicator of chronic kidney disease in patients with nonalcoholic fatty liver disease.

This study was designed to determine the diagnostic value of liver stiffness measured by transient elastography (TE) in identifying chronic kidney disease (CKD) in individuals with ultrasonography-diagnosed NAFLD. A total of 1439 adult patients with ultrasonography-diagnosed NAFLD between October 2015 and August 2017 in China-Japan union hospital of Jilin university were initially eligible. According to the exclusion criteria, 24 patients were excluded, and eventually, a total of 1415 patients were included in the study. The AST/ALT ratio and FIB-4 score were calculated from blood tests, and liver stiffness was measured using TE. The liver stiffness measured by TE, FIB-4 score, ALT/AST ratio were significantly elevated in CKD patients, compared with those without CKD (P<0.001). The areas under the curve (AUROC) of liver stiffness, FIB-4 score and AST/ALT ratio were 0.694 (0.670-0.718), 0.707 (0.682-0.730), 0.712 (0.688-0.736), showing no statistically significant difference between these three tests. Further, multivariate analysis identified four independent risk factors for CKD: age, diabetes mellitus, serum uric acid, and liver stiffness. Also, the performance of these four independent variables taken together in a logistic regression model for identifying CKD was 0.834 (AUROC; 95%CI: 0.814-0.853), showing a higher diagnostic performance than that of a single application of liver stiffness. Liver stiffness assessed by TE is a potential indicator for CKD in ultrasonography-diagnosed NAFLD patients. Further, a four-variable model (liver stiffness, age, serum uric acid, and diabetes mellitus) could be a useful tool for identifying subjects at high risk for CKD in NAFLD patients.

38. Direct and indirect costs associated with the treatment of chronic hepatitis C with chronic kidney disease in India: a cost of illness study

38. Direct and indirect costs associated with the treatment of chronic hepatitis C with chronic kidney disease in India: a cost of illness study

Chronic Kidney Disease in India: A Clarion Call for Change.

CKD, with its high prevalence, morbidity and mortality, is an important public health problem. With <3% of land mass, India hosts 17% of the Earth’s population. Large numbers of patients below the poverty line, low gross domestic product, and low monetary allocations for health care have led to

Circulating α-Klotho is Related to Plasma Aldosterone and Its Follow-Up Change Predicts CKD Progression

Background/Aims: We aimed to determine if soluble α-klotho level was an indicator of chronic kidney disease (CKD) progression and whether α-klotho interacted with aldosterone during the course of further renal damage. Methods: 112 adults with stages 1–5 CKD were enrolled into our cohort study. All of the patients were followed up for 6 years (from January 2010 to December 2015). Serum soluble α-klotho and aldosterone were measured at baseline and at 1.5-years follow-up. The primary outcome was the initiation of renal replacement therapy (RRT) and the secondary outcome was the occurrence of cardio-cerebrovascular events. Long-term progression to RRT and cardio-cerebrovascular events in patients was analyzed with a risk-adjusted Cox proportional hazards regression model. Adjustment included age, gender, eGFR, mean arterial pressure, 24-h protein excretion and the change in α-klotho level from baseline at 1.5-years follow-up. Results: Baseline circulating α-klotho levels were positively associated with baseline estimated glomerular filtration rate (eGFR; r = 0.224, p = 0.017), but not age, calcium, phosphate, or parathyroid hormone levels. The change in α-klotho level from baseline at 1.5-years follow-up (p = 0.002) was independently associated with renal replace treatment (RRT) initiation after adjustment for age, gender, eGFR, mean arterial pressure, and 24-h protein excretion in Cox regression analysis. Aldosterone levels were positively associated with CKD stage, and were inversely correlated with circulating α-klotho levels. Conclusion: The change in concentration of soluble α-klotho during the 1.5-years follow-up was an indicator of CKD progression. Renal damage associated with a reduction of α-klotho may involve the upregulation of plasma aldosterone. Future studies are needed to validate our findings, and to investigate the underlying mechanism by which α-klotho and aldosterone may cause renal damage.