The occurrence and potential predictive factors of major adverse cardiac and cerebral events in end-stage renal disease patients on continuous ambulatory peritoneal dialysis: A prospective cohort study

The Correlation Between Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) and miR-142-3p in Maintenance Hemodialysis Patients With End-Stage Renal Disease

BACKGROUND

Patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) are at high risk for major adverse cardiovascular and cerebrovascular events (MACCE), which are prone to be detrimental to patients' lives. Identifying risk factors for MACCE can help target measures to prevent or reduce the occurrence of MACCE.

OBJECTIVE

The aim was to investigate the correlation between miR-142-3p and MACCE in ESRD patients on MHD and to provide a new predictor for MACCE occurrence.

METHODS

Blood samples were collected from subjects to detect the expression of miR-142-3p using RT-qPCR. The correlation of miR-142-3p with HDL-C and hs-CRP was assessed by the Pearson method. The occurrence of MACCE in patients during the 36-month follow-up period was recorded. The clinical value of miR-142-3p in MACCE occurrence was analyzed by the Kaplan-Meier curve, multivariate logistic regression, and ROC curve.

RESULTS

In ESRD patients on MHD, miR-142-3p was downregulated, and it showed a positive correlation with HDL-C but a negative correlation with hs-CRP. The cumulative incidence of MACCE at 1, 2, and 3 years was 8.9%, 20.0%, and 30.4%, respectively. miR-142-3p levels were reduced in patients who developed MACCE and were associated with the cumulative incidence of MACCE. miR-142-3p was a risk factor for MACCE and showed a predictive value with specificity and sensitivity of 89.36% and 56.10%, respectively.

CONCLUSIONS

miR-142-3p was a risk factor of MACCE in ESRD patients undergoing MHD.

Significance of serum NLRP3 as a potential predictor of 5-year death in hemodialysis patients: A prospective observational cohort study

Nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) is involved in inflammatory response. This study was done to explore the role of serum NLRP3 as a predictive biomarker of death after hemodialysis. In this prospective observational study of 331 patients undergoing maintenance hemodialysis, serum NLRP3 levels were measured. Univariate analysis and multivariate analysis were sequentially performed to determine predictors of 5-year death after hemodialysis. Age, major adverse cardiac and cerebral events (MACCE), and serum NLRP3 levels independently predicted 5-year mortality and overall survival (all P < .05). No interactions were found between serum NLRP3 levels and other variables, such as age, gender, hypertension, diabetes mellitus, primary renal diseases, and MACCE (all P interaction > .05). Serum NLRP3 levels were linearly correlated with risk of death and overall survival under restricted cubic spline (both P > .05) and substantially discriminated patients at risk of death under receiver operating characteristic curve (P < .001). Two models, in which age, MACCE, and serum NLRP3 were combined, were built to predict 5-year mortality and overall survival. The mortality prediction model had significantly higher predictive ability than age, AMCCE, and serum NLRP3 alone under receiver operating characteristic curve (all P < .05). The models, which were graphically represented by nomograms, performed well under calibration curve and decision curve. Serum NLRP3 levels are independently related to 5-year mortality and overall survival of patients after hemodialysis, suggesting that serum NLRP3 may be a potential prognostic biomarker of hemodialysis patients.

Annual survival of patients with end-stage chronic kidney disease on supportive hemodialysis and its correlates

OBJECTIVE

Aim: The aim of the study was to determine the relationship of residual renal function, markers of inflammation and protein-energy expenditure with annual survival in patients undergoing hemodialysis.

PATIENTS AND METHODS

Materials and Methods: The work was a prospective cohort study and included 299 patient data. Residual kidney function was determined by urine volume of more than 250 ml per day to assess the effect. According to this criterion, the patients were divided into two groups. The degree of chronic inflammation was assessed by the content of acute phase proteins (ferritin and C-reactive protein) in the blood serum. The serum albumin level was chosen as a marker of protein-energy expenditure. The survival rate of patients with residual renal function was higher as compared to patients without it (p<0.001).

RESULTS

Results: In the current study, the absence of residual kidney function increased the risk of mortality from all causes in patients who had recently undergone hemodialysis by almost 30 times during the first year of substitution therapy. C-reactive protein was also associated with poorer survival in these patients (HR=1.01; 95% CI: 1-1.02), while albumin was inversely associated with mortality (HR=0.92; 95% CI: 0.87-0.98).

CONCLUSION

Conclusions: Thus, residual renal function and higher serum albumin levels by the time maintenance hemodialysis begins are independent predictors of the best survival during the first year of replacement therapy. The presence of residual kidney function of less than 250 ml and a higher level of C-reactive protein correlated with an increased risk of mortality in these patients.

Correlation of serum omentin-1 level with clinical features and major adverse cardiac and cerebral events in patients undergoing continuous ambulatory peritoneal dialysis

Omentin-1 shows a critical protective role of cardiovascular events in chronic kidney disease. This study aimed to further assess serum omentin-1 level and its relationship with clinical features and accumulating major adverse cardiac/cerebral events (MACCE) risk in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis (CAPD-ESRD). Totally, 290 CAPD-ESRD patients and 50 healthy controls (HCs) were recruited, and their serum omentin-1 levels were measured by enzyme-linked immunosorbent assay. All CAPD-ESRD patients were followed up for 36 months to assess accumulating MACCE rate. Omentin-1 level in CAPD-ESRD patients was lower than that in HCs [median (interquartile range): 229.350 (153.575-355.550) vs. 449.800 (354.125-527.450) pg/mL] (p < 0.001). Moreover, omentin-1 level was inversely related to C-reactive protein (CRP) (p = 0.028), total cholesterol (p = 0.023), and low-density lipoprotein cholesterol (p = 0.005), while there was no correlation in omentin-1 level with other clinical features in CAPD-ESRD patients. The accumulating MACCE rate was 4.5%, 13.1%, and 15.5% in the first, second, and third years respectively, and it was lower in CAPD-ESRD patients with high level of omentin-1 than those with low level of omentin-1 (p = 0.004). Furthermore, omentin-1 (hazard ratio (HR)=0.422, p = 0.013) and high-density lipoprotein cholesterol (HR = 0.396, p = 0.010) were independently associated with reduced accumulating MACCE rate; while age (HR = 3.034, p = 0.006), peritoneal dialysis duration (HR = 2.741, p = 0.006), CRP (HR = 2.289, p = 0.026), serum uric acid (HR = 2.538, p = 0.008) were independently related to higher accumulating MACCE rate in CAPD-ESRD patients. In conclusion, serum high omentin-1 level is associated with decreased inflammation, lipid levels, and accumulating MACCE risk in CAPD-ESRD patients.

Kt/V reach rate is associated with clinical outcome in incident peritoneal dialysis patients

Background

The urea clearance index (Kt/V) is an important index for predicting the clinical outcome of peritoneal dialysis (PD) patients, but it changes with time depending on the clinical condition. This study aimed to investigate the association between the Kt/V reach rate (defined as the percentage of Kt/V measurements that reached ≥ 1.70) and clinical outcome in incident PD patients.

Methods

In this retrospective cohort study, 210 patients were enrolled from the First Affiliated Hospital of Zhengzhou University from 1 January 2013 to 31 October 2019. The target Kt/V reach rate in the first year was applied as the predictor variable. Kaplan-Meier survival curves were drawn to evaluate differences in prognosis. The association between Kt/V reach rate and the composite clinical outcome (death or transfer to hemodialysis) was tested by Cox regression analysis.

Results

The dialysis adequacy group (Kt/V reach rate 3/3 times) and the dialysis intermittent adequacy group (1/3 or 2/3 times) had significantly better clinical outcomes than the dialysis inadequacy group (0/3 times). There was no difference in clinical outcome between the lower-rate group (reach rate 1/3 times) and the higher-rate group (2/3 times). Compared with the dialysis inadequacy group, the dialysis intermittent adequacy group and dialysis adequacy group had significantly lower risks of the composite outcome (HR 0.487, 95% CI 0.244–0.971, p = 0.041; HR 0.150, 95% CI 0.043–0.520, p = 0.003) in the fully adjusted analysis.

Conclusion

Higher Kt/V reach rates are associated with a better prognosis in incident PD patients.

Longitudinal change in microRNA-130a expression and its correlation with the risk of developing major adverse cardiovascular and cerebral events in patients undergoing continuous ambulatory peritoneal dialysis

BACKGROUND

MicroRNA-130a (miR-130a) regulates angio-cellular dysregulation, atherosclerosis, and cardiocerebral injuries, serving as a biomarker for major adverse cardiovascular and cerebral events (MACCE) in several chronic diseases. However, its clinical application in patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD), who are at a high risk of developing MACCE, has not been reported. Therefore, this study aimed to explore this aspect.

METHODS

miR-130a expression in peripheral blood mononuclear cells obtained from 50 healthy controls (HCs) at recruitment and 257 ESRD patients undergoing CAPD at month (M)0, M12, M24, and M36 was determined by reverse transcription-quantitative polymerase chain reaction. ESRD patients undergoing CAPD were followed up until MACCE occurred or M36. Then, MACCE were recorded, and MACCE-free survival was calculated.

RESULTS

miR-130a expression was significantly lower in ESRD patients undergoing CAPD than in HCs (p < 0.001). In addition, miR-130a expression significantly decreased from M0 to M36 in ESRD patients undergoing CAPD (p < 0.001). Moreover, miR-130a expression at M0, M12, and M24 was significantly lower in patients with MACCE than in those without MACCE (all p < 0.05). Furthermore, high miR-130a expression at M0, M12, and M36 was significantly correlated with prolonged MACCE-free survival in ESRD patients undergoing CAPD (all p < 0.05), and high miR-130a expression at M0 was an independent factor for improved MACCE-free survival (p = 0.015; hazard ratio (HR) (95% confidential interval): 0.456 (0.243-0.857)).

CONCLUSION

miR-130a expression decreases continuously with disease progression in patients with ESRD undergoing CAPD. Additionally, this expression is negatively correlated with MACCE risk in these patients.