Abstract

Background and aims: Chronic inflammation is receiving much attention as a critical pathology that induces various aging phenotypes, a concept known as “inflammaging’’. Uremic patients receiving hemodialysis show vascular aging phenotypes characterized by greater arterial stiffness and calcification compared to healthy controls. In this study, we investigated whether levels of inflammaging markers in the circulation were associated with vascular aging phenotypes in uremic patients, as estimated by the cardio-ankle vascular index (CAVI). Methods: We conducted a multicenter cross-sectional study of patients undergoing hemodialysis and evaluated the relationship between circulating high-sensitivity C-reactive protein (hs-CRP) or angiopoietin-like protein (ANGPTL) 2 levels, as markers of inflammaging, and CAVI. Results: Of 412 patients, 376 were statistically analyzed. While circulating hs-CRP levels had no significant association with CAVI, linear regression models revealed that high ANGPTL2 levels in circulation were significantly associated with increasing CAVI after adjustment for classical metabolic factors and hemodialysis-related parameters. Exploratory analysis revealed that high circulating ANGPTL2 levels were also strongly associated with increased CAVI, particularly in patients with elevated blood pressure, elevated pulse pressure, or excess body fluid. Conclusions: We conclude that circulating levels of ANGPTL2 rather than hs-CRP are positively associated with CAVI in the uremic patients and that ANGPTL2 could be a unique biomarker of progression of vascular aging in patients receiving hemodialysis.

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