Abstract
Objective: The (pro)renin receptor [(P)RR] is cleaved to generate soluble (P)RR [s(P)RR], which reflects the status of the tissue renin-angiotensin system. Hemodialysis (HD) patients have advanced atherosclerosis and a poor prognosis due to an increased prevalence of cardiovascular diseases. We have previously reported that serum s(P)RR levels were associated with arteriosclerosis independent of other risk factors. The present study aimed to investigate whether serum s(P)RR levels are associated with worsening of cardiac function. Design and method: A total of 258 maintenance HD patients were recruited and serum s(P)RR concentrations were measured. The patients were divided into lower (L) and higher (H) s(P)RR groups, and the background factors were compared between the two groups. Background factors were compared between those who survived (S) and who died (D group) during the 12-months-follow-up period. In the S group, the relationships between s(P)RR levels and changes in background factors including cardiac functions and atherogenic factors during the follow-up period were evaluated. Results: Serum s(P)RR concentrations were 29.8 ± 5.3 ng/ml. Age, CTR, TG, CRP, and visceral fat area (VFA) were significantly higher in H group than in L group. Twenty-four patients died during the follow-up period, and age, CTR, CRP, hANP, BNP, E/e’ were significantly higher and BMI, HDL-C, Cre, Alb, left ventricular ejection fraction (LVEF), subcutaneous fat area (SFA), and VFA were significantly lower in D group than in S group. In S group, changes in hANP or BNP were significantly higher in H group than in L group. Multiple regression analyses testing s(P)RR, LDL-C, LVMI, and LVEF, which were significantly correlated with changes in BNP, as independent variables revealed that s(P)RR was significantly positively correlated with changes in BNP. Conclusions: High serum s(P)RR levels were shown to be associated with increases in BNP independent of other risk factors, suggesting that increased expression of (P)RR may be associated with progression of heart failure in HD patients. Further studies are needed to determine whether serum s(P)RR levels are associated with prognosis in these patients.
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