Abstract
Patients with chronic kidney disease (CKD), especially those who are hemodialyzed (HD), are at significantly high risk of contracting cardiovascular disease and having increased mortality. This study aimed to find potential death predictors, the measurement of which may reflect increased mortality in HD patients, and then combine the most promising ones in frames of a simple death risk assessment model. For this purpose, HD patients () with acute myocardial infarction in the last year (HD group) and healthy people (control group) as a comparative group () were included in the study. Various laboratory determinations and non-invasive cardiovascular tests were performed. Next, patients were followed for two years, and data on cardiovascular (CV) deaths were collected. On this basis, two HD groups were formed: patients who survived (HD-A, ) and patients who died (HD-D, ). To model HD mortality, 21 out of 90 potential variables collected or calculated from the raw data were selected. The best explanatory power (95.5%) was reached by a general linear model with four variables: interleukin 18, 3-nitrotyrosine, albumin, and phosphate. The interplay between immuno-inflammatory processes, nitrosative and oxidative stress, malnutrition, and calcium-phosphate disorders has been indicated to be essential in predicting CV-related mortality in studied HD patients. ClinicalTrials.gov Identifier: NCT05214872.
Highlights
Introduction iationsChronic kidney disease (CKD), defined as a progressive loss of functional nephrons leading to a gradual reduction in the glomerular filtration rate (GFR) and increased urinary albumin excretion, has become a global public health problem [1] and a recognized risk factor for cardiovascular disease (CVD) [2].Epidemiological studies have shown that in 2017, the global incidence of chronic kidney disease (CKD) was9.1%
Patients forming the HD-D showed an estimated GFR (eGFR) slightly higher than the HD-A, and the urea serum concentration was lower in the HD-D vs. HD-A. high-sensitivity C-reactive protein (hsCRP), a marker of the low-grade inflammatory process, was higher among the HD-D group compared to the HD-A group
As the adaptive immune system is involved in the development of atherosclerosis, the importance of interleukin 18 (IL-18) is considered crucial, especially when we focus on CKD-related atherosclerosis and its clinically relevant consequences [28]
Summary
Introduction iationsChronic kidney disease (CKD), defined as a progressive loss of functional nephrons leading to a gradual reduction in the glomerular filtration rate (GFR) and increased urinary albumin excretion, has become a global public health problem [1] and a recognized risk factor for cardiovascular disease (CVD) [2].Epidemiological studies have shown that in 2017, the global incidence of CKD was9.1%. Chronic kidney disease (CKD), defined as a progressive loss of functional nephrons leading to a gradual reduction in the glomerular filtration rate (GFR) and increased urinary albumin excretion, has become a global public health problem [1] and a recognized risk factor for cardiovascular disease (CVD) [2]. Epidemiological studies have shown that in 2017, the global incidence of CKD was. Whereas it increased in all age groups by 29.3% between 1990 and 2017, the agestandardized global incidence has not changed significantly. CKD caused 1.2 million deaths in 2017 and has been found to be the 12th most common cause of death globally. 7.6% of all CVD deaths have been linked to impaired kidney function. Deaths from CKD or CVD attributed to CKD have accounted for 4.6% of all deaths.
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