1
|
Liberale L, Torino C, Pizzini P, Mezzatesta S, D'Arrigo G, Gori M, Carbone F, Schiavetta E, Cugno V, Cabri M, Sgura C, Maioli E, Mbarga D, Rubini G, Tirandi A, Ramoni D, Mallamaci F, Tripepi G, Zoccali C, Montecucco F. Plasma levels of myeloperoxidase and resistin independently predict mortality in dialysis patients. Eur J Intern Med 2024; 129:87-92. [PMID: 39019736 DOI: 10.1016/j.ejim.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/28/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND In patients with kidney failure (KF) undergoing dialysis, neutrophils are dysfunctionally activated. Such chronic activation does not correspond to increased protection against infections and is thought to cause direct vascular damage accounting for the higher incidence of cardiovascular (CV) events. We hypothesized that circulating levels of neutrophil degranulation products (i.e. myeloperoxidase (MPO) and resistin) can predict overall and CV-specific mortality in dialysis patients. METHODS MPO and resistin levels were assessed in plasma samples from n = 1182 dialysis patients who were followed-up for median 2.9 years (IQR: 1.7-4.2). RESULTS Patients were 65 ± 14 (SD) years old and 36 % women. Median value of MPO and resistin were 78 ng/mL (IQR: 54 - 123) and 72 ng/mL (IQR: 46 - 110), respectively. MPO and resistin levels correlated with biomarkers of organ damage, nutritional status and inflammation. Both MPO and resistin levels predicted all-cause mortality even after adjustment for traditional risk factors and inflammation, nutritional and KF-related indexes (MPO, HRfor 1 ln unit increase: 1.26, 95 %CI 1.11 - 1.42, P < 0.001; Resistin, HRfor 1 ln unit increase: 1.25, 95 %CI 1.09 - 1.44, P = 0.001). Similarly, their predictive ability held true also for CV death (MPO, HRfor 1 ln unit increase: 1.19, 95 %CI 1.01 - 1.41, P = 0.04; Resistin, HRfor 1 ln unit increase: 1.29, 95 %CI 1.07 - 1.56, P = 0.007). CONCLUSION Plasma levels of MPO and resistin correlate with prospective overall and CV-specific mortality risk in KF patients undergoing dialysis and might be useful prognostic tools. Mediators of inflammation may be potential target to improve survival of those patients.
Collapse
Affiliation(s)
- Luca Liberale
- IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, 10 Largo Rosanna Benzi, 16132 Genoa, Italy; First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Claudia Torino
- Clinical Epidemiology of Renal Disease and Hypertension Unit. Reggio Cal CNR Unit of the Pisa CNR Institute of Clinical Physiology, Italy
| | - Patrizia Pizzini
- Clinical Epidemiology of Renal Disease and Hypertension Unit. Reggio Cal CNR Unit of the Pisa CNR Institute of Clinical Physiology, Italy
| | - Sabrina Mezzatesta
- Clinical Epidemiology of Renal Disease and Hypertension Unit. Reggio Cal CNR Unit of the Pisa CNR Institute of Clinical Physiology, Italy
| | - Graziella D'Arrigo
- Clinical Epidemiology of Renal Disease and Hypertension Unit. Reggio Cal CNR Unit of the Pisa CNR Institute of Clinical Physiology, Italy
| | | | - Federico Carbone
- IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, 10 Largo Rosanna Benzi, 16132 Genoa, Italy; First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Elisa Schiavetta
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Valeria Cugno
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Mara Cabri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Cosimo Sgura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Elia Maioli
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Danielle Mbarga
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Gianluca Rubini
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Amedeo Tirandi
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Davide Ramoni
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Francesca Mallamaci
- Clinical Epidemiology of Renal Disease and Hypertension Unit. Reggio Cal CNR Unit of the Pisa CNR Institute of Clinical Physiology, Italy; Nephrology, Hypertension and Renal Transplantation Unit, Grande Ospedale Metropolitano, Reggio Cal. Italy
| | - Giovanni Tripepi
- Clinical Epidemiology of Renal Disease and Hypertension Unit. Reggio Cal CNR Unit of the Pisa CNR Institute of Clinical Physiology, Italy
| | - Carmine Zoccali
- Renal Research Institute, New York, USA; IPNET, c/o Nefrologia del Grande Ospedale Metropolitano, Reggio Cal. Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, 10 Largo Rosanna Benzi, 16132 Genoa, Italy; First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.
| |
Collapse
|
2
|
Wang R, Liang Y, Jiang J. Association between the geriatric nutritional risk index and clinical outcomes among peritoneal dialysis patients: A meta-analysis. Medicine (Baltimore) 2024; 103:e38048. [PMID: 38701289 PMCID: PMC11062730 DOI: 10.1097/md.0000000000038048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND To identify the relationship between the geriatric nutritional risk index (GNRI) and clinical outcomes in patients receiving peritoneal dialysis (PD). METHODS The PubMed, EBASE, Web of Science and CNKI databases were searched for available studies up to December 25, 2023. The primary outcome was all-cause mortality, and the secondary outcomes included the incidence of PD dropout, major adverse cardiac and cerebrovascular events (MACCEs), technique failure and peritonitis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were combined to evaluate the predictive value of the GNRI for the occurrence of the above endpoints. RESULTS Ten cohort studies with 3897 patients were included. The pooled results demonstrated that a lower GNRI was significantly associated with a greater incidence of all-cause mortality (HR = 0.71, 95% CI: 0.55-0.91; P = .007). In addition, a decreased GNRI predicted the occurrence of dropout from PD (HR = 0.971, 95% CI: 0.945-0.998, P = .034) and MACCE (HR = 0.95, 95% CI: 0.92-0.98, P = .001). However, no significant associations of the GNRI with technique failure (P = .167) or peritonitis (P = .96) were observed. CONCLUSION A low GNRI is significantly associated with poor clinical outcomes and might serve as a novel and valuable prognostic indicator among PD patients.
Collapse
Affiliation(s)
- Renjie Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yuxiang Liang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jiaojiao Jiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| |
Collapse
|
3
|
Yarragudi R, Gessl A, Vychytil A. New-Onset Diabetes Mellitus in Peritoneal Dialysis and Hemodialysis Patients: Frequency, Risk Factors, and Prognosis-A Review. Ther Apher Dial 2019; 23:497-506. [PMID: 30854792 PMCID: PMC6916572 DOI: 10.1111/1744-9987.12800] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/03/2019] [Accepted: 03/08/2019] [Indexed: 12/23/2022]
Abstract
New-onset diabetes mellitus (NODM) is observed in both hemodialysis (HD) and peritoneal dialysis (PD) patients. The prevalence of NODM in dialysis patients is slightly higher compared to subjects of the general population. Based on currently published data there is no convincing evidence that the risk of NODM is different between HD and PD patients. Data on the effect of glucose load on risk of NODM in dialysis patients remain controversial. PD modality (automated or continuous ambulatory PD) has no significant influence on NODM incidence. Chronic inflammation is associated with NODM in dialysis patients. Reported differences in NODM between PD and HD patients are possibly also influenced by differences in demographic factors between these patient groups. Mortality in NODM patients is lower than mortality in patients with preexisting DM. This may be partly explained by the younger age and lower number of comorbidities in patients with NODM.
Collapse
Affiliation(s)
- Rajashri Yarragudi
- Clinical Division of Nephrology and Dialysis, Department of Medicine IIIMedical University of ViennaViennaAustria
| | - Alois Gessl
- Clinical Division of Endocrinology and Metabolism, Department of Medicine IIIMedical University of ViennaViennaAustria
| | - Andreas Vychytil
- Clinical Division of Nephrology and Dialysis, Department of Medicine IIIMedical University of ViennaViennaAustria
| |
Collapse
|
4
|
Zhang RN, Hao HF, Zhang W, Li Q, Ren LJ, Jia L, Wei F, Chen HY, Wang Z, Bi XQ, Pang HY, Jiang AL, Wei YL. Clinical characterization and prognostic implications of metabolic syndrome in patients undergoing peritoneal dialysis at a Chinese center. J Int Med Res 2019; 47:5573-5583. [PMID: 31533550 PMCID: PMC6862897 DOI: 10.1177/0300060519875335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective Metabolic syndrome (MS) is a common clinical condition associated with cardiovascular disease in patients undergoing peritoneal dialysis (PD); however, its prognostic implication among patients receiving PD remains controversial. Methods In a prospective study from January 2013 and June 2016, we enrolled 190 patients undergoing PD and followed them for 46.4 ± 30.7 months. We assessed the associations of clinical characteristics and measurements with diabetes mellitus (DM) status, MS, and prognostic outcomes among the included patients. Results We found that DM was associated with shortened duration of dialysis and poor survival. The prevalence of MS was 58.9% among all patients. We found significant differences in age, body weight, body mass index, triglycerides, high-density lipoprotein cholesterol, fasting plasma glucose, leukocytes, platelets, neutrophil percentage, and pre-albumin between patients with and without MS. We found a negative correlation trend between serum intact parathyroid hormone and MS among our patients. The arteriosclerosis index was significantly elevated in the MS group compared with the non-MS group. Serum calcium concentration and frequency of hospital admissions were significantly associated with mortality and technique failure. Conclusions MS was positively associated with cardiovascular disease. DM, and hypocalcemia. Frequent hospital admissions can predict poor prognosis in patients undergoing PD.
Collapse
Affiliation(s)
- Rui-Ning Zhang
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hui-Fang Hao
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China.,Department of Nephrology, Tianjin TEDA Hospital, Tianjin, China
| | - Wei Zhang
- Department of Immunology, Biochemistry and Molecular Biology, 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Tianjin Key Laboratory of Medical Epigenetics, Tianjin Medical University, Tianjin, China.,Department of Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin Medical University, Tianjin, China
| | - Qing Li
- Department of Nephrology, Tianjin TEDA Hospital, Tianjin, China
| | - Li-Jie Ren
- Department of Immunology, Biochemistry and Molecular Biology, 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Tianjin Key Laboratory of Medical Epigenetics, Tianjin Medical University, Tianjin, China
| | - Lan Jia
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fang Wei
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hai-Yan Chen
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhe Wang
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xue-Qing Bi
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hai-Yan Pang
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ai-Li Jiang
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yi-Liang Wei
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China.,Department of Immunology, Biochemistry and Molecular Biology, 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Tianjin Key Laboratory of Medical Epigenetics, Tianjin Medical University, Tianjin, China
| |
Collapse
|