骨桥蛋白与血液透析患者的临床结局

Osteopontin and Clinical Outcomes in Hemodialysis Patients.

作者信息

Torino Claudia, Carbone Federico, Pizzini Patrizia, Mezzatesta Sabrina, D'Arrigo Graziella, Gori Mercedes, Liberale Luca, Moriero Margherita, Michelauz Cristina, Frè Federica, Isoppo Simone, Gavoci Aurora, Rosa Federica La, Scuricini Alessandro, Tirandi Amedeo, Ramoni Davide, Mallamaci Francesca, Tripepi Giovanni, Montecucco Fabrizio, Zoccali Carmine

机构信息

Clinical Epidemiology of Renal Disease and Hypertension Unit, Reggio Cal CNR Unit of the Pisa CNR Institute of Clinical Physiology, 89124 Reggio Calabria, Italy.

First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.

出版信息

Biomedicines. 2024 Nov 14;12(11):2605. doi: 10.3390/biomedicines12112605.

DOI:10.3390/biomedicines12112605

PMID:39595171

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11592156/

Abstract

BACKGROUND/OBJECTIVES: Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are significant public health issues, with cardiovascular morbidity and mortality being the leading causes of death in hemodialysis patients. Osteopontin (OPN), a multifunctional glycoprotein, has emerged as a potential biomarker for vascular disease in CKD due to its role in inflammation, tissue remodeling, and calcification.

METHODS

This cohort study included 1124 hemodialysis patients from the PROGREDIRE study, a registry involving 35 dialysis units in Southern Italy. Serum osteopontin levels were measured using enzyme-linked immunosorbent assay (ELISA). The primary endpoints were all-cause and cardiovascular mortality. Multivariate Cox regression analyses were performed to assess the association between osteopontin levels and mortality, adjusting for traditional risk factors, biomarkers of inflammation, nutritional status, and ESKD-related factors.

RESULTS

During a mean follow-up of 2.8 years, 478 patients died, 271 from cardiovascular causes. Independent correlates of osteopontin included alkaline phosphatase and parathyroid hormone. Elevated osteopontin levels were significantly associated with increased all-cause mortality (HR 1.19, 95% CI 1.09-1.31, < 0.001) and cardiovascular mortality (HR 1.22, 95% CI 1.08-1.38, = 0.001) after adjusting for confounders.

CONCLUSIONS

Elevated osteopontin levels are associated with increased all-cause and cardiovascular mortality in hemodialysis patients. These findings implicate osteopontin in the high risk for death and cardiovascular disease in the hemodialysis population. Intervention studies are needed to definitively test this hypothesis.

摘要

背景/目的：慢性肾脏病（CKD）和终末期肾病（ESKD）是重大的公共卫生问题，心血管疾病的发病率和死亡率是血液透析患者死亡的主要原因。骨桥蛋白（OPN）是一种多功能糖蛋白，因其在炎症、组织重塑和钙化中的作用，已成为CKD血管疾病的潜在生物标志物。

方法

这项队列研究纳入了来自PROGREDIRE研究的1124例血液透析患者，该研究是一项涉及意大利南部35个透析单位的登记研究。采用酶联免疫吸附测定（ELISA）法检测血清骨桥蛋白水平。主要终点是全因死亡率和心血管死亡率。进行多变量Cox回归分析，以评估骨桥蛋白水平与死亡率之间的关联，并对传统危险因素、炎症生物标志物、营养状况和ESKD相关因素进行校正。

结果

在平均2.8年的随访期间，478例患者死亡，其中271例死于心血管原因。骨桥蛋白的独立相关因素包括碱性磷酸酶和甲状旁腺激素。校正混杂因素后，骨桥蛋白水平升高与全因死亡率增加（HR 1.19，95%CI 1.09 - 1.31，P < 0.001）和心血管死亡率增加（HR 1.22，95%CI 1.08 - 1.38，P = 0.001）显著相关。