With almost 3.7 million people in the UK diagnosed with diabetes, research at King’s is hoping to open doors to new treatments for complications experienced by many patients with both type 1 and type 2 diabetes.

Klotho and diabetes

Led by Dr Janaka Karalliedde, researchers in the  School of Cardiovascular Medicine & Sciences  have been examining a hormone called Klotho which is thought to play a significant role in the development of kidney disease, a condition often prevalent in patients with diabetes.

The potential impact and cost savings to the NHS of being able to identify those at risk of kidney failure earlier is massive

– Dr Janaka Karalliedde, School of Cardiovascular Medicine & Sciences

 

A  study in 2017  tested blood and urine samples from patients with type 1 diabetes, some of which also showed signs of the early stages of diabetic kidney disease, called microalbuminuria.

The researchers found that patients with microalbuminuria had lower levels of the circulating Klotho hormone, compared with patients without microalbuminuria. Klotho levels in patients without microalbuminuria were similar to levels found in healthy adults.

This suggested that Klotho may play a significant role in the development of kidney disease linked to diabetes.

Predicting kidney function

The  most recent study  then looked at 101 patients with type 2 diabetes over the course of nine years and found that future decline in kidney function could be predicted by looking at levels of Klotho in the blood. Patients with lower levels of Klotho had a four times higher risk of significant loss of renal function than those with normal Klotho levels.

Dr  Nikolaos Fountoulakis  and Dr  Giuseppe Maltese, joint first authors of this work, said: ‘This means Klotho could be used to identify those at risk of kidney failure much earlier than is currently possible and may have a huge impact on how we treat complications of diabetes.’

Protecting vascular systems

Previous evidence has also shown that Klotho has a protective effect on vascular systems so the researchers further hope that the hormone could also provide a new avenue for research around treatments that could increase Klotho levels and potentially prevent kidney disease altogether.

Dr Karalliedde commented: ‘Our studies provide a much needed evidence base that Klotho plays a role in diabetic kidney disease for both type 1 and type 2. The potential impact and cost savings to the NHS of being able to identify those at risk of kidney failure earlier is massive – it costs around £60,000 a year for one patient to receive dialysis treatment.

‘More research is needed to determine whether the Klotho deficiency actually causes kidney disease or whether it is a by-product of something else that is happening in the body. But if we were able to reduce the number of people requiring dialysis treatment, even by identifying earlier those that required preventative medications, that would both improve quality of life for those people and save money for the NHS.’