Cerqueira Ana, Quelhas-Santos Janete, Ferreira Inês, Sampaio Susana, Relvas Miguel, Marques Nídia, Dias Cláudia Camila, Pestana Manuel
Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal.
Department of Medicine, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal.
Life (Basel). 2021 Mar 8;11(3):210. doi: 10.3390/life11030210.
Chronic kidney disease (CKD) is an independent risk factor for adverse cardiovascular and cerebrovascular events (MACCEs), and mortality since the earlier stages. Therefore, it is critical to identify the link between CKD and cardiovascular risk (CVR) through early and reliable biomarkers. Acknowledging that CKD and CKD progression are associated with increased sympathetic tone, which is implicated in CVR, and that renalase metabolizes catecholamines, we aimed to evaluate the relationship between renalase serum levels (RNLS) and cardiovascular and renal outcomes. The study included 40 pre-dialysis CKD patients (19F:21M) with median age of 61 (IQ 45-66) years. At baseline, we measured RNLS as well as routine biomarkers of renal and cardiovascular risk. A prospective analysis was performed to determine whether RNLS are associated with CKD progression, MACCEs, hospitalizations and all-cause mortality. At baseline, the median level of RNLS and median estimated glomerular filtration rate (eGFR) were 63.5 (IQ 48.4-82.7) µg/mL and 47 (IQ 13-119) mL/min/1.73 m, respectively. In univariate analysis, RNLS were strongly associated with eGFR, age and Charlson Index. Over the course of a mean follow-up of 65 (47 to 70) months, 3 (7.5%) deaths, 2 (5%) fatal MACCEs, 17 (42.5%) hospital admissions occurred, and 16 (40%) patients experienced CKD progression. In univariate analysis, RNLS were associated with CKD progression ( = 0.001), hospitalizations ( = 0.001) and all-cause mortality ( = 0.022) but not with MACCEs ( = 0.094). In adjusted analysis, RNLS predicted CKD progression and hospitalizations regardless of age, Charlson comorbidity index, cardiovascular disease, hypertension, diabetes and dyslipidemia. Our results suggest that RNLS, closely related with renal function, might have a potential role as predictor of renal outcomes, hospitalizations, and mortality in pre-dialysis CKD patients.
慢性肾脏病（CKD）是心血管和脑血管不良事件（MACCEs）以及早期即出现的死亡的独立危险因素。因此，通过早期且可靠的生物标志物来确定CKD与心血管风险（CVR）之间的联系至关重要。鉴于CKD及其进展与交感神经张力增加有关，而交感神经张力又与CVR相关，且肾酶可代谢儿茶酚胺，我们旨在评估肾酶血清水平（RNLS）与心血管及肾脏结局之间的关系。该研究纳入了40例透析前CKD患者（19名女性：21名男性），中位年龄为61（四分位间距45 - 66）岁。在基线时，我们测量了RNLS以及肾脏和心血管风险的常规生物标志物。进行了一项前瞻性分析，以确定RNLS是否与CKD进展、MACCEs、住院情况及全因死亡率相关。在基线时，RNLS的中位水平和中位估计肾小球滤过率（eGFR）分别为63.5（四分位间距48.4 - 82.7）μg/mL和47（四分位间距13 - 119）mL/min/1.73 m²。在单因素分析中，RNLS与eGFR、年龄和Charlson指数密切相关。在平均随访65（47至70）个月的过程中，发生了3例（7.5%）死亡、2例（5%）致命性MACCEs、17例（42.5%）住院情况，并且16例（40%）患者出现了CKD进展。在单因素分析中，RNLS与CKD进展（P = 0.001）、住院情况（P = 0.001）及全因死亡率（P = 0.022）相关，但与MACCEs无关（P = 0.094）。在多因素分析中，无论年龄、Charlson合并症指数、心血管疾病、高血压、糖尿病和血脂异常情况如何，RNLS均可预测CKD进展和住院情况。我们的结果表明，与肾功能密切相关的RNLS可能在预测透析前CKD患者的肾脏结局、住院情况及死亡率方面具有潜在作用。
