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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Endothelial dysfunction, inflammation and malnutrition markers as predictors of mortality in dialysis patients:
Aleksandra M Ignjatović1, Tatjana P Cvetković, Radmila M Pavlović
1Department of Medical Statistics, Faculty of Medicine Niš, University of Niš, Boulevard Zorana Djindjica 81, 18000, Nis, Serbia, drsalea@yahoo.com.
Insights
A multimarker approach combining endothelial dysfunction, inflammation, and malnutrition markers significantly improves risk stratification for mortality in dialysis patients. Patients with multiple risk factors face substantially higher mortality risks, highlighting the value of this comprehensive strategy.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biomarker Research
Background:
- Cardiovascular disease is a leading cause of mortality in dialysis patients.
- A multimarker approach offers a comprehensive strategy for risk stratification by integrating various pathophysiological components.
- Existing risk stratification methods may not fully capture the complex interplay of factors contributing to adverse outcomes in this population.
Purpose of the Study:
- To evaluate the combined predictive value of markers for endothelial dysfunction (ADMA), inflammation (CRP, SAA), and malnutrition (albumin) in dialysis patients.
- To determine if a multimarker approach enhances risk stratification compared to individual markers.
- To assess the association between the number of risk markers and mortality, including cardiovascular mortality.
Main Methods:
- A prospective 3-year follow-up study included 153 prevalent hemodialysis patients.
- Measurements included asymmetric dimethylarginine (ADMA) by HPLC, C-reactive protein (CRP) and serum amyloid A (SAA) by immunonephelometry, and albumin by standard automated methods.
- Patients were stratified into groups based on the presence of high ADMA, high CRP, high SAA, and low albumin levels.
Main Results:
- Patients with one, two, or three or more risk markers exhibited significantly increased adjusted hazard ratios for all-cause mortality (2.419, 6.720, 10.455, respectively).
- Similarly, adjusted hazard ratios for cardiovascular mortality increased with the number of risk markers (1.838, 9.924, 14.823, respectively).
- The presence of multiple risk markers was strongly associated with elevated mortality risk.
Conclusions:
- The combined predictive value of multiple risk markers is superior to that of individual factors for assessing mortality risk in dialysis patients.
- A multimarker approach provides a more effective tool for risk stratification in this vulnerable patient group.
- Identifying and managing multiple risk factors is crucial for improving outcomes in patients undergoing dialysis.
Backgrounds:
Cardiovascular disease is reported to be major cause of mortality in dialysis patients. Multimarker approach is new approach in risk stratification. Creating a common predictive value, many different pathophysiological components are covered. The aim of this study was to examine the combined predictive value of markers of endothelial dysfunction (ADMA), inflammation (CRP, SAA) and malnutrition (albumin) in dialysis patients.
Methods:
In this prospective 3-year follow-up study, 153 prevalent patients (105 males and 48 females) on hemodialysis were included. ADMA were measured by HPLC; CRP and SAA were measured using immunonephelometric assays. Albumins were measured by the use of standard methods on the automated analyzer. The patients were stratified into five groups based on the presence of 1, 2, and 3 or more risk markers, respectively, namely high ADMA (≥0.49 μmol/L), high CRP (≥6.0 mg/L), high SAA (≥7.6 mg/L) and low albumin (<30.3 g/L).
Results:
The patients with 1, 2, 3 or more risk markers had an adjusted hazard ratio (HR) of 2.419 (0.728-8.034), 6.720 (2.100-21.503), 10.455 (3.193-24.227), respectively, for mortality, compared to those without risk markers. The patients with 1, 2, 3 or more risk markers had an adjusted HR of 1.838 (0.307-11.006), 9.924 (2.052-28.003), 14.823 (0.2.962-34.189), respectively, for cardiovascular mortality than those without risk markers.
Conclusions:
The results of this study demonstrate that the common predictive value of several markers is higher than individual predictive value of examined risk factors. Patients with multiple risk factors had higher mortality. Multimarker approach provides an opportunity for better risk stratification in dialysis patients.
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