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Prognostic value of plasma myeloperoxidase in ESRD patients
Angela Yee-Moon Wang1, Christopher Wai-Kei Lam, Iris Hiu-Shuen Chan
1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. aymwang@hku.hk
Background:
Myeloperoxidase (MPO) has been suggested to have a role in atherosclerosis through its strong oxidative capacity. We hypothesized that MPO level may predict clinical outcomes in patients with end-stage renal disease receiving long-term peritoneal dialysis (PD) therapy.
Study Design:
Prospective cohort study.
Setting & Participants:
236 long-term PD patients were recruited from a single regional dialysis unit in Hong Kong between April 1999 and February 2001.
Predictor:
Level of plasma MPO, analyzed using a sandwich enzyme-linked immunosorbent assay.
Outcome & Measurement:
Mortality and fatal or nonfatal cardiovascular events at 3 years.
Results:
The distribution of MPO levels was skewed with a median of 31.8 μg/L (25th-75th percentiles, 24.4-42.7). There were 69 deaths and 81 cardiovascular events. Adjusting for traditional and nontraditional risk factors and C-reactive protein, cardiac troponin T, and N-terminal pro-brain natriuretic peptide levels, a doubling in plasma MPO level was associated independently with a 46% (95% CI, 1.02-2.08; P = 0.04) and 60% (95% CI, 1.17-2.18; P = 0.003) increase in risks of mortality and cardiovascular events, respectively. Log(2)MPO showed significant additional predictive value for mortality (P = 0.04) and cardiovascular events (P = 0.005) when included in Cox regression models consisting of clinical, demographic, dialysis, echocardiographic, and biochemical parameters, as well as C-reactive protein, cardiac troponin T, and N-terminal pro-brain natriuretic peptide levels.
Limitations:
MPO was measured at a single time and did not reflect changes over time.
Conclusions:
These data suggest that plasma MPO level has significant independent and additional prognostic value beyond the standard clinical, biochemical, and echocardiographic parameters and is useful for outcome stratification in long-term PD patients. MPO may be an important mediator of increased cardiovascular risk in patients with end-stage renal disease and warrants further investigation.
