Abstract 5219: Reduced Number of CD34+ Circulating Progenitor Cells Predict Long-term Cardiovascular Outcome in Chronic Kidney Disease Patients With Hemodialysis

Abstract

Background: Patients with chronic kidney disease(CKD) on hemodialysis (HD) are the highest risk population for cardiovascular (CV) disease, and endothelial dysfunction is regarded as an important cause of CV risk in this population. Circulating endothelial progenitor cells (EPCs) are believed to be involved in maintenance of endothelial integrity, and are close proximity to CD34+ circulating progenitor cells (CPCs). We prospectively examined whether reduced number of CD34+ CPCs would predict long-term CV outcome in HD patients. Methods: The number of CD34+ CPCs was determined with the use of flow-cytometry in blood sample before dialysis session in 216 outer HD patients. To avoid the influence of body fluid overload, the ratio of CD34+ CPCs to peripheral mononuclear cells (CD34+/PMNCs) were calculated. The patients were divided into tertiles according to CD34+/PMNCs levels; tertile 1 (T1): <0.012, T2: 0.013–0.022 and T3: >0.023 (n=72 each), and were prospectively followed for 4 years. Results: During 42±10months, 67 CV events and 35 deaths (21 CV deaths) occurred. Four-year event-free survival were 54%, 68% and 82% for CV events (p=0.0013), 78%, 92% and 98% for CV death (p=0.0009) and 73%, 84% and 93% for all-cause death (p=0.0058) in T1, T2 and T3, respectively. On Cox multivariate analysis, reduced CD34+CPCs levels were independent predictor for CV events (HR 2.40, 95%CI 1.25–4.62, p=0.028 for T1 vs. T3), for CV death (HR 5.46, 95%CI 1.18–25.26, p=0.029 for T1 vs. T3) and for all-cause death (HR 3.72, 95%CI 1.37–10.09, p=0.030 for T1 vs. T3), respectively. Conclusion: These data suggest that reduced number of CD34+ CPCs predicts long-term CVoutcome in CKD patients with HD.