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A New and Robust Prognostic Biomarker for Mortality Risk Prediction in Dialysis Patients With Coronary Artery
Xuecheng Zhao1, Enmin Xie2, Zhengqin Zhai1
1Department of Cardiology, China-Japan Friendship Hospital, Affiliated With Capital Medical University, 100029 Beijing, China.
Insights
The red cell distribution width-to-albumin ratio (RAR) is an independent predictor of poor outcomes in dialysis patients with coronary artery disease (CAD). An elevated RAR signifies increased risks for mortality and major adverse cardiovascular events (MACEs).
Area of Science:
- Cardiology
- Nephrology
- Biomarker Discovery
Background:
- Coronary artery disease (CAD) is a major cause of death in dialysis patients.
- Traditional risk factors inadequately predict CAD prognosis in this population.
- Novel biomarkers are needed for improved risk stratification.
Purpose of the Study:
- To evaluate the red cell distribution width-to-albumin ratio (RAR) as a predictor of clinical outcomes in dialysis patients with CAD.
- To assess the association between RAR and all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs).
Main Methods:
- A multicenter cohort study of 1128 CAD patients on dialysis.
- Patients were stratified into tertiles based on RAR.
- Primary endpoints included all-cause and cardiovascular mortality; secondary endpoint was MACEs.
Main Results:
- Patients in the highest RAR tertile had significantly increased risks of all-cause mortality (HR 1.592), cardiovascular mortality (HR 1.503), and MACEs (HR 1.452) compared to the lowest tertile.
- A linear, dose-dependent association was observed between elevated RAR and adverse outcomes.
- Integrating RAR into existing risk models improved predictive performance.
Conclusions:
- An elevated red cell distribution width-to-albumin ratio (RAR) is an independent predictor of poor outcomes in patients with coronary artery disease undergoing dialysis.
- RAR can enhance risk stratification for adverse events in this high-risk group.
Background:
Coronary artery disease (CAD) remains a fundamental etiology of morbidity and mortality among patients receiving dialysis, a cohort known to have a particularly poor prognosis. While traditional CAD risk factors, such as hyperlipidemia, hypertension, and diabetes, remain noteworthy, these factors do not fully capture the complexity of the disease in dialysis patients. Therefore, innovative and robust biomarkers that can refine risk stratification and enhance prognostic precision in this vulnerable population are imperative. Hence, this study aimed to evaluate the use of the red cell distribution width-to-albumin ratio (RAR) to predict clinical outcomes, particularly in dialysis patients with CAD.
Methods:
We analyzed data from a multicenter cohort of 1128 CAD patients on dialysis who were enrolled between January 2015 and June 2021. Patient stratification into tertiles was performed based on RARs. The primary endpoints were all-cause mortality and cardiovascular mortality. The secondary endpoint was the occurrence of major adverse cardiovascular events (MACEs), comprising non-fatal myocardial infarction, non-fatal stroke, and other cardiovascular events.
Results:
The median follow-up duration was 20.9 months 378 (33.5%) patients experienced all-cause mortality, 261 (19.1%) cardiovascular mortality, and 485 (43.0%) MACEs. In multivariable Cox proportional hazards regression, patients in the highest RAR tertile demonstrated remarkably escalated risks of all-cause mortality (hazard ratio (HR): 1.592, 95% confidence interval (CI): 1.212-2.092), cardiovascular mortality (HR: 1.503, 95% CI: 1.086-2.080), and MACEs (HR: 1.452, 95% CI: 1.141-1.846) compared with those in the lowest tertile. Moreover, restricted cubic spline analysis revealed a linear, dose-dependent association between elevated RAR and an increased risk of these adverse outcomes. The integration of the RAR into existing risk models, specifically the Global Registry of Acute Coronary Events and Gensini scores, noticeably amplified the predictive performance, as demonstrated by notable enhancements in both net reclassification improvement and integrated discrimination improvement.
Conclusions:
An elevated RAR serves as an independent predictor of poor outcomes in patients with CAD undergoing dialysis.
Clinical Trial Registration:
This study was registered at ClinicalTrials.gov (Identifier: NCT05841082; https://clinicaltrials.gov/study/NCT05841082).
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