Yi Jiahong, Jiang Chang, Xia Liangping
Department of VIP Region, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
Ren Fail. 2025 Dec;47(1):2464828. doi: 10.1080/0886022X.2025.2464828. Epub 2025 Feb 26.
Few studies have focused on the correlation between leukocyte telomere length (LTL) and cancer-related mortality or identified potential factors that mediate the relationship between LTL and mortality among chronic kidney disease (CKD) patients. Our study aimed to explore the associations between LTL and all-cause and cause-specific mortality and to identify the underlying mediators.
CKD patients were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Cox regression analysis and restricted cubic spline analysis were used to explore the associations between LTL and all-cause or specific-cause mortality and their nonlinear connections. Stratified analyses were executed to assess the relationships among the different subgroups. The latent mediated factors were confirmed using mediation analysis. Sensitivity analyses were used to evaluate the robustness of our findings.
Longer LTL associated with the lower risk of all-cause mortality, cardiovascular disease (CVD) and cancer-related mortality, and U-shaped relationships were detected. Patients younger than 65 years with greater LTL or who had hypertension had better prognoses. Age and history of hypertension were associated with LTL and overall mortality. In addition, estimated glomerular filtration rate (eGFR), albumin, and total bilirubin mediated the association, and the proportions of indirect effects were 7.81%, 3.77%, and 2.50%, respectively. Six sensitivity analyses confirmed the robustness of our findings.
This study revealed that LTL was a protective factor for survival among patients with CKD and emphasized the mediating roles of oxidative stress and kidney function.
很少有研究关注白细胞端粒长度（LTL）与癌症相关死亡率之间的相关性，或确定介导慢性肾脏病（CKD）患者LTL与死亡率之间关系的潜在因素。我们的研究旨在探讨LTL与全因死亡率和特定病因死亡率之间的关联，并确定潜在的介导因素。
CKD患者来自1999 - 2002年美国国家健康与营养检查调查（NHANES）。采用Cox回归分析和限制立方样条分析来探讨LTL与全因或特定病因死亡率之间的关联及其非线性联系。进行分层分析以评估不同亚组之间的关系。使用中介分析确定潜在的介导因素。采用敏感性分析来评估我们研究结果的稳健性。
LTL较长与全因死亡率、心血管疾病（CVD）和癌症相关死亡率风险较低相关，且发现呈U形关系。年龄小于65岁且LTL较长或患有高血压的患者预后较好。年龄和高血压病史与LTL和总体死亡率相关。此外，估计肾小球滤过率（eGFR）、白蛋白和总胆红素介导了这种关联，间接效应的比例分别为7.81%、3.77%和2.50%。六项敏感性分析证实了我们研究结果的稳健性。
本研究表明LTL是CKD患者生存的保护因素，并强调了氧化应激和肾功能的介导作用。
