Zhang Zhen, Zhang Lin, Dong Xinyue, Shen Bo, Xiang Fangfang, Cao Xuesen, Yu Jinbo, Wang Yaqiong, Ding Xiaoqiang, Nie Yuxin
Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, University, No 180 Fenglin Road, Shanghai, China.
Department of Cardiology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, China; Department of Nursing, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, China.
Clin Chim Acta. 2025 Jan 1;564:119937. doi: 10.1016/j.cca.2024.119937. Epub 2024 Aug 21.
End-stage renal disease (ESRD) necessitating hemodialysis pose substantial cardiovascular risks, with cardiovascular disease (CVD) as a leading cause of mortality. Biomarkers like copeptin have emerged as potential indicators of cardiovascular stress and prognosis in CKD populations.
This study aimed to assess the prognostic value of copeptin in predicting major adverse cardiovascular events (MACEs) among hemodialysis patients, alongside traditional cardiac biomarkers.
ESRD patients undergoing maintenance hemodialysis were enrolled. Copeptin levels were measured, and patients were followed for MACEs, defined as cardiovascular deaths, myocardial infarction, stroke, or heart failure-related hospitalizations. Cox proportional-hazards models were used to evaluate the association between copeptin and outcomes, adjusting for relevant covariates.
Among 351 patients followed for a median of 22.7 months, elevated copeptin levels were significantly associated with an increased risk of MACEs (HR 1.519, 95 % CI 1.140 to 2.023; p = 0.00425). Copeptin demonstrated predictive capability across multiple statistical tests (Log-rank p = 0.024; Gehan p < 0.001; Tarone-Ware p < 0.001; Peto-Peto p = 0.027), although significance was attenuated in pairwise comparisons post-adjustment for multiple testing. Combining copeptin with NT-proBNP or hs-cTnT further enhanced risk stratification for MACEs.
Elevated copeptin levels independently predict adverse cardiovascular outcomes in hemodialysis patients. Integrating copeptin with traditional cardiac biomarkers may refine risk stratification and guide personalized therapeutic strategies in this high-risk population.
需要进行血液透析的终末期肾病（ESRD）带来了重大的心血管风险，心血管疾病（CVD）是主要的死亡原因。诸如 copeptin 等生物标志物已成为慢性肾脏病（CKD）人群中心血管应激和预后的潜在指标。
本研究旨在评估 copeptin 在预测血液透析患者主要不良心血管事件（MACE）方面的预后价值，以及与传统心脏生物标志物相比的情况。
纳入接受维持性血液透析的 ESRD 患者。测量 copeptin 水平，并对患者进行随访，观察 MACE，其定义为心血管死亡、心肌梗死、中风或与心力衰竭相关的住院治疗。使用 Cox 比例风险模型评估 copeptin 与结局之间的关联，并对相关协变量进行调整。
在中位随访时间为 22.7 个月的 351 例患者中，copeptin 水平升高与 MACE 风险增加显著相关（风险比[HR]为 1.519，95%置信区间[CI]为 1.140 至 2.023；p = 0.00425）。copeptin 在多项统计检验中均显示出预测能力（对数秩检验 p = 0.024；Gehan 检验 p < 0.001；Tarone-Ware 检验 p < 0.001；Peto-Peto 检验 p = 0.027），尽管在多重检验调整后的两两比较中显著性有所减弱。将 copeptin 与 N 末端脑钠肽原（NT-proBNP）或高敏心肌肌钙蛋白 T（hs-cTnT）联合使用可进一步增强 MACE 的风险分层。
copeptin 水平升高可独立预测血液透析患者的不良心血管结局。将 copeptin 与传统心脏生物标志物相结合，可能会优化这一高危人群的风险分层并指导个性化治疗策略。
