The influence of Klotho protein and prooxidant–antioxidant balance combination on the mortality of HD patients

Tamara Milošević*, Miron Sopić, Jelena Vekić, Azra Guzonjić, Sanja Vujčić, Snežana Pešić, Milica Miljković-Trailović, Radomir Naumović, Jelena Kotur-Stevuljević

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review


Purpose: End-stage renal disease patients on chronic hemodialysis (HD) have a shortened life expectancy compared to the general population. The aim of this study was to evaluate a possible link between three new and emerging factors in renal pathophysiology: Klotho protein, telomere length in peripheral blood mononuclear cells (TL) and redox status parameters before HD (bHD) and after HD (aHD), and to test mortality prediction capability of these emerging parameters in a population of HD patients. Methods: The study included 130 adult patients with average age 66 (54–72), on HD (3 times per week; 4–5 h per session). Klotho level, TL, routine laboratory parameters, dialysis adequacy and redox status parameters: advanced oxidation protein products (AOPP), prooxidant–antioxidant balance (PAB), superoxide anion (O2.−), malondialdehyde (MDA), ischemia-modified albumin (IMA), total sulfhydryl group content (SHG), and superoxide dismutase (SOD) were determined. Results: Klotho concentration was significantly higher aHD; 68.2 (22.6–152.9) vs. bHD 64.2 (25.5–119.8) (p = 0.027). The observed increase in TL was not statistically significant. AOPP, PAB, SHG, and SOD activity were significantly increased aHD (p > 0.001). The patients with the highest mortality risk score (MRS) had significantly higher PAB bHD (p = 0.002). Significantly lower O2.− (p < 0.001), SHG content (p = 0.072), and IMA (p = 0.002) aHD were found in patients with the lowest MRS values. Principal component analysis revealed redox balance-Klotho factor as a significant predictor of high mortality risk (p = 0.014). Conclusion: Decreased Klotho and TL attrition as well as redox status disturbance could be connected with higher mortality rate in HD patients.

Original languageEnglish
Pages (from-to)615-623
Number of pages9
JournalInternational Urology and Nephrology
Issue number2
Publication statusPublished - Feb 2024
Externally publishedYes


  • Hemodialysis
  • Klotho protein
  • Oxidative stress
  • Telomeres


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