Inflammation and Dysregulated Bone Turnover Confound Serum ICAM-1 as a Cardiovascular Marker in Hemodialysis

Area of Science:

• Nephrology
• Cardiology
• Biomarker Discovery

Background:

• Cardiovascular disease (CVD) is the primary cause of death in hemodialysis (HD) patients.
• Intercellular adhesion molecule-1 (ICAM-1) has been explored as a potential CVD biomarker, but its clinical utility remains unproven.
• Low-grade inflammation and chronic kidney disease-mineral bone disorder (CKD-MBD) are common comorbidities in HD patients that may influence biomarker reliability.

Purpose of the Study:

• To investigate the potential of serum ICAM-1 as a CVD biomarker in hemodialysis patients.
• To evaluate the impact of confounding factors, including inflammation and CKD-MBD, on the diagnostic value of serum ICAM-1 for CVD.
• To assess the relationship between serum ICAM-1, endothelial dysfunction (nitric oxide), and CKD-MBD (bone alkaline phosphatase).

Main Methods:

• A cohort of 142 hemodialysis patients was studied.
• Serum ICAM-1, routine biochemical parameters, bone alkaline phosphatase (bALP), and nitric oxide (NO) were measured.
• Patients were assessed for cardiovascular disease based on a history of coronary heart disease, stroke, or peripheral arterial disease. Inflammation was indicated by C-reactive protein levels.

Main Results:

• Serum ICAM-1, bALP, and NO levels did not differ significantly between patients with and without CVD.
• Serum ICAM-1 concentrations were elevated in patients with inflammation (CRP >1 mg/dL).
• Serum ICAM-1 showed no correlation with NO but was positively correlated with bALP.

Conclusions:

• Serum ICAM-1 is not a reliable biomarker for diagnosing cardiovascular disease in hemodialysis patients.
• The diagnostic utility of ICAM-1 is confounded by the presence of inflammation and disturbances in mineral bone metabolism.
• Further research is needed to identify reliable CVD biomarkers in this high-risk population.