title: Increased circulating inflammatory proteins predict a worse prognosis with valvular calcification in end-stage renal disease: a prospective cohort study.
abstract: BACKGROUND
  It remains unknown whether inflammation may predict a worse prognosis with valvular calcification (VC) in end-stage renal disease (ESRD) patients.
  
  
  METHODS
  We prospectively performed echocardiography in 231 ESRD patients receiving chronic peritoneal dialysis treatment to detect VC and then followed them for 3 years or until death.
  
  
  RESULTS
  Patients with VC had higher C-reactive protein (CRP; p = 0.001), higher interleukin-6 (IL-6; p = 0.002) and lower fetuin-A (p = 0.004). Stratifying patients into 4 groups on the basis of VC, CRP, IL-6 and fetuin-A, respectively, those with VC and CRP in the upper tertile had 3.68-fold (95% confidence intervals [CI], 1.72-7.88; p = 0.001) and 3.13-fold (95% CI, 1.57-6.24; p = 0.001) respective increases in the adjusted risk of mortality and major adverse cardiovascular event (MACE) than those with no VC and CRP in the lower/middle tertiles. The adjusted hazard ratios (HR) in relation to mortality and MACE were 3.56 (95% CI, 1.53-8.26; p = 0.003) and 2.51 (95% CI, 1.24-5.11; p = 0.011), respectively, for patients with VC and IL-6 in the upper tertile compared to those with no VC and IL-6 in the lower/middle tertiles. The adjusted HR in relation to mortality and MACE were 3.56 (95% CI, 1.53-8.26; p = 0.003) and 2.51 (95% CI, 1.24-5.11; p = 0.011), respectively, for patients with VC and fetuin-A in the lower tertile compared to those with no VC and fetuin-A in the middle/upper tertiles.
  
  
  CONCLUSIONS
  Increased circulating inflammatory proteins predict a worse prognosis of VC in chronic peritoneal dialysis patients.
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China. aymwang@hku.hk
authors.forename: Angela Yee-Moon
authors.initials: AY
authors.lastname: Wang
authors.forename: Christopher Wai-Kei
authors.initials: CW
authors.lastname: Lam
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.forename: Iris Hiu-Shuen
authors.initials: IH
authors.lastname: Chan
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.forename: Sui-Fai
authors.initials: SF
authors.lastname: Lui
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
mesh_terms: D002097:C-Reactive Protein / Q000032:analysis*; D002114:Calcinosis / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006351:Heart Valves / Q000473:pathology*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D015850:Interleukin-6; D000509:alpha-Fetoproteins; D002097:C-Reactive Protein