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Exp Gerontol. 2019 Jul 15;122:123-128. doi: 10.1016/j.exger.2019.05.003. Epub 2019 May 8.

Physical performance, plasma S-klotho, and all-cause mortality in elderly dialysis patients: A prospective cohort study.

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Department of Systems Biology, University of Alcalá, Madrid, Spain. Electronic address:
Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.
Nephrology Unit, Hospital General de Villalba, Madrid, Spain.
ImFINE Research Group, Faculty of Physical Activity and Sport Sciences, Universidad Politécnica de Madrid, Madrid, Spain.
Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain.


The secreted protein form of the α-klotho gene, S-klotho, is gaining popularity as a predictor of overall morbimortality, and its role in dialysis patients has been recently highlighted. However, physical performance -which can be assessed through practical field-tests- might be a more practical prognostic marker. The present study aimed to analyze the relationship between physical performance, plasma S-klotho and all-cause mortality in this population. 30 male hemodialysis patients (71 ± 9 years) participated in this prospective, cohort study. Their plasma S-klotho levels and physical performance (assessed by means of the 6-minute walk test [6MWT], handgrip strength, and the sit-to-stand test [STS]) were determined at baseline, and the incidence of mortality was assessed 18-month later. Lower S-klotho levels were associated with a worse performance in all physical tests (all p < 0.05). 12 participants died during the 18 months following baseline measurements. An increased mortality risk was observed in those patients with a worse performance in the STS (RR: 3.0 [95%CI: 1.01-8.95], p < 0.05), the handgrip test (RR: 3.0 [95%CI: 1.01-8.95], p < 0.05) and the 6MWT (RR: 5.0 [95%CI: 1.31-19.07], p < 0.01), being the latter the best predictor of mortality. By contrast, this relationship was not found for plasma S-klotho (RR: 1.6 [95%CI: 0.65-1.35], p > 0.05). In summary, low plasma S-klotho levels are related to impaired physical performance in male dialysis patients. However, physical performance appears as a better and more practical predictor of mortality in this patient population.


Biomarker; Physical performance; Physical tests; Predictors; Sarcopenia

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