Department of Internal Diseases and Dialysis Unit, West Hospital of Saint John Paul II, Daleka 11, 05-825 Grodzisk Mazowiecki, Poland.
Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warszawa, Poland; Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Pawińskiego 5A, 02-106 Warszawa, Poland.
Cytokine. 2019 Aug;120:9-14. doi: 10.1016/j.cyto.2019.04.002. Epub 2019 Apr 13.
Patients with chronic kidney disease (CKD) have a high risk of death mainly due to cardiovascular diseases (CVD). Early risk identification may allow interventions and prevention of fatal events.
The study aim was to assess the usefulness of selected CVD biomarkers as predictors of 5-year mortality in patients with different CKD stages.
Study included 57 CKD patients: 38 in stage 5 (ESRD), 19 in stage 3 and 4 (CKD3-4), and 19 healthy controls. Blood samples were obtained once to measure fetuin A, adiponectin, leptin, tumor necrosis factor (TNF), interleukin-6 (IL-6), metalloproteinase-9 (MMP9), intracellular-1 (ICAM1) and vascular-1 (VCAM1) adhesion molecules (ELISA or Luminex platform). Computed tomography was performed to assess the calcium score (CS). Patients were prospectively followed for 5 years to evaluate their all-cause mortality.
Serum VCAM1, TNF and IL-6 were significantly higher in more advanced CKD stages. VCAM1 correlated significantly with ICAM1, TNF and IL-6. TNF and IL-6 were also significantly correlated with each other. No significant changes were detected for other markers. IL-6 correlated significantly with CS, age, renal function and CRP. Elevated CS and IL-6 increased over 3 times the 5-year all-cause and cardiovascular mortality risks in patients with CKD or ESRD at baseline.
IL-6 and CS were significantly associated with 5-year risk of all-cause mortality in CKD patients. Our study suggests an involvement of chronic inflammation linked to coronary artery calcification that is likely to contribute to the cardiovascular mortality in patients with impaired renal function.
患有慢性肾脏病（CKD）的患者主要死于心血管疾病（CVD）的风险较高。早期识别风险可能允许进行干预并预防致命事件。
本研究旨在评估选定的 CVD 生物标志物作为不同 CKD 阶段患者 5 年死亡率预测因子的有用性。
本研究纳入了 57 名 CKD 患者：38 名处于 5 期（ESRD），19 名处于 3 期和 4 期（CKD3-4），19 名健康对照者。采集一次血液样本以测量胎球蛋白 A、脂联素、瘦素、肿瘤坏死因子（TNF）、白细胞介素-6（IL-6）、金属蛋白酶-9（MMP9）、细胞内-1（ICAM1）和血管-1（VCAM1）黏附分子（ELISA 或 Luminex 平台）。进行计算机断层扫描以评估钙评分（CS）。前瞻性随访患者 5 年以评估其全因死亡率。
更晚期 CKD 阶段的血清 VCAM1、TNF 和 IL-6 显着升高。VCAM1 与 ICAM1、TNF 和 IL-6 显着相关。TNF 和 IL-6 彼此之间也显着相关。其他标志物未检测到显着变化。IL-6 与 CS、年龄、肾功能和 CRP 显着相关。在基线时患有 CKD 或 ESRD 的患者中，升高的 CS 和 IL-6 使 5 年全因和心血管死亡率风险增加了 3 倍以上。
IL-6 和 CS 与 CKD 患者 5 年全因死亡风险显着相关。我们的研究表明，与冠状动脉钙化相关的慢性炎症可能与肾功能受损患者的心血管死亡率有关。
