Increased circulating inflammatory proteins predict a worse prognosis with valvular calcification in end-stage renal disease: a prospective cohort study.
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.
Wang
Angela Yee-Moon
AY
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China. aymwang@hku.hk
Lam
Christopher Wai-Kei
CW
Wang
Mei
M
Chan
Iris Hiu-Shuen
IH
Yu
Cheuk-Man
CM
Lui
Sui-Fai
SF
Sanderson
John E
JE
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*
D015850:Interleukin-6; D000509:alpha-Fetoproteins; D002097:C-Reactive Protein