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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Circulating TNF receptors predict cardiovascular disease in patients with chronic kidney disease

Eunjin Bae1, Ran-Hui Cha, Yong C Kim

  • 1Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon Department of Internal Medicine, National Medical Center Department of Internal Medicine, Seoul National University College of Medicine Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul Department of Internal Medicine, Dongguk University Medical Center, Gyeongju Department of Internal Medicine, Dong-A University, Busan Department of Dental Hygiene, College of Health Science, Eulji University, Seongnam Department of Internal Medicine, Yonsei University College of Medicine, Seoul Department of Internal Medicine, Dongguk University Medical Center, Goyang Kidney Research Institute, Seoul National University, Seoul, Republic of Korea.

Medicine
|May 11, 2017
PubMed

Insights

Circulating tumor necrosis factor receptors (cTNFRs) show promise as biomarkers for predicting cardiovascular disease (CVD) risk in chronic kidney disease (CKD) patients. Elevated cTNFR1 and cTNFR2 levels independently predict CVD events, offering new insights for risk assessment in CKD.

Area of Science:

  • Nephrology
  • Cardiology
  • Biomarker Discovery

Background:

  • Cardiovascular disease (CVD) is a major cause of mortality in chronic kidney disease (CKD) patients.
  • There is a critical need for reliable biomarkers to predict CVD risk in this population.
  • Circulating tumor necrosis factor receptors (cTNFRs) are implicated in inflammatory processes relevant to CVD.

Purpose of the Study:

  • To investigate the association between circulating tumor necrosis factor receptor 1 (cTNFR1) and 2 (cTNFR2) levels and the risk of CVD events in patients with CKD.
  • To determine if cTNFRs can serve as independent predictors of CVD morbidity and mortality in CKD.
  • To explore the relationship between cTNFR levels and established CKD risk factors like estimated glomerular filtration rate (eGFR) and urinary protein-to-creatinine ratio (UPCR).

Main Methods:

  • A prospective cohort study involving 984 CKD patients recruited from 11 centers.
  • Measurement of serum cTNFR1 and cTNFR2 levels using enzyme-linked immunosorbent assay (ELISA).
  • Longitudinal follow-up for a mean of 4 years to ascertain CVD events, analyzed using Cox proportional hazard models, adjusted for clinical covariates.

Main Results:

  • Elevated serum levels of cTNFR1 and cTNFR2 were observed in CKD patients.
  • Both cTNFR1 and cTNFR2 levels were significantly correlated with markers of kidney function, including eGFR and UPCR.
  • In multivariate analysis, higher levels of cTNFR1 (HR 2.506) and cTNFR2 (HR 4.156) independently predicted CVD risk, even after adjusting for eGFR, UPCR, and high-sensitivity C-reactive protein.

Conclusions:

  • Circulating tumor necrosis factor receptors (cTNFR1 and cTNFR2) are associated with cardiovascular disease risk factors in CKD patients.
  • cTNFRs serve as independent predictors of CVD events in CKD, irrespective of kidney function markers like eGFR and UPCR.
  • cTNFRs represent promising novel biomarkers for CVD risk stratification in individuals with chronic kidney disease.

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