Department of Internal Medicine, Division of Nephrology, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Faculty of Family Medicine and Primary care, University of Protestant in Congo, Kinshasa, Democratic Republic of Congo.
BMC Nephrol. 2022 Mar 30;23(1):123. doi: 10.1186/s12882-022-02748-0.
Cardiovascular (CV) disease is the leading cause of mortality in patients with end-stage kidney disease (ESKD). The aim of the present study was to determine whether Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) could be an independent predictor of CV events and all-cause mortality in black African haemodialysis patients.
We carried out a prospective cohort study of all consecutive hemodialysis (HD) patients between August 2016 and July 2020, admitted in six hemodialysis centers of Kinshasa, Democratic Republic of Congo. Independent determinants of plasma PCSK-9 measured by ELISA were sought using multiple linear regression analysis. Kaplan-Meier's method described the incidence of CV events while competitive and proportional risk models looked for independent risk factors for death at the .05 significance level.
Out of 207 HD patients, 91 (43.9%) died; 116 (56.1%) have survived. PCSK9 level was significantly higher in deceased patients compared to survivors: 28.0 (24.0-31.0) ng/l vs 9.6 (8.6-11.6) ng/ml (p < 0.001). Patients with plasma PCSK9 levels in tertile 3 had a higher incidence of CV events and mortality compared to patients with plasma PCSK9 levels in tertile 2 or tertile 1 (p < 0.001). Tertile 3 negatively influence survival rates (26.6%) compared to tertile 2 (54.7%) and tertile 1 (85.3%). Patients in tertile 3 and tertile 2 had a 4-fold higher risk of death than patients in tertile 1. After adjustment for all parameters, competitive risk analysis showed that mortality was 2 times higher in patients with stroke. Similarly, serum albumin < 3.5 g/dL or PCSK9 in tertile 3 were respectively associated with 2 or 6 times higher rates of deaths.
Elevated plasma PCSK9 level is an independent major predictor of incident CV events and all-cause mortality in black African HD patients.
心血管疾病是终末期肾病（ESKD）患者死亡的主要原因。本研究旨在确定前蛋白转化酶枯草溶菌素/柯萨奇蛋白酶 9（PCSK9）是否可作为黑种人血液透析患者心血管事件和全因死亡率的独立预测因子。
我们进行了一项前瞻性队列研究，纳入了 2016 年 8 月至 2020 年 7 月期间刚果民主共和国金沙萨的 6 个血液透析中心的所有连续血液透析（HD）患者。使用多元线性回归分析寻找通过 ELISA 测量的血浆 PCSK-9 的独立决定因素。Kaplan-Meier 法描述了心血管事件的发生率，竞争和比例风险模型寻找死亡的独立危险因素，显著性水平为 0.05。
在 207 名 HD 患者中，91 名（43.9%）死亡；116 名（56.1%）存活。与幸存者相比，死亡患者的 PCSK9 水平显著升高：28.0（24.0-31.0）ng/L 比 9.6（8.6-11.6）ng/ml（p<0.001）。血浆 PCSK9 水平处于第三三分位数的患者发生心血管事件和死亡率均高于血浆 PCSK9 水平处于第二或第一三分位数的患者（p<0.001）。第三三分位数对生存率的影响（26.6%）低于第二三分位数（54.7%）和第一三分位数（85.3%）。与第一三分位数相比，第三三分位数和第二三分位数的患者死亡风险高 4 倍。调整所有参数后，竞争风险分析显示中风患者的死亡率高 2 倍。同样，血清白蛋白<3.5 g/dL 或 PCSK9 处于第三三分位数与死亡率分别高 2 倍或 6 倍相关。
升高的血浆 PCSK9 水平是黑种人血液透析患者心血管事件和全因死亡率的独立主要预测因子。
