Low levels of IgM antibodies against phosphorylcholine-A increase mortality risk in patients undergoing haemodialysis.
BACKGROUND
Atherosclerosis is an inflammatory disease where oxidized low-density lipoprotein may play an important role through phosphorylcholine (PC)-exposing inflammatory phospholipids. Both atherosclerosis and its clinical consequence cardiovascular disease (CVD) are highly prevalent in patients with end-stage renal disease (ESRD). We here study the association between IgM antibodies against phosphorylcholine-A (anti-PC) and risk of death in patients undergoing haemodialysis (HD).


METHODS
We performed a prospective observational study examining the relationship between anti-PC concentrations and mortality risk in a well-characterized cohort of 203 prevalent HD patients [56% men, median age 66 (interquartile range 51-74) years, vintage time 29 (15-58) months] with a mean follow-up period of 29 (14-58) months.


RESULTS
Median anti-PC levels were lower in HD patients with systemic collagen vascular disease (18.9 versus 45.2 U/mL, P = 0.01) and in patients who died during the follow-up period (29.5 versus 53.9 U/mL; P = 0.0008). The patients with an anti-PC value below the median (42.1 U/mL) had a higher mortality rate with a crude hazard ratio (HR) of 2.13 (95% CI 1.40-3.22). These patients remained at higher risk of death (HR 1.76; 95% CI 1.13-2.74) even after adjustment for traditional risk factors (age, sex, smoking habits, CKD aetiology, CVD and diabetes), protein-energy wasting and inflammation (HR 1.70; 95% CI 1.19-2.68).


CONCLUSIONS
Low levels of natural IgM antibodies against PC are independent predictors of death among HD patients. Further studies are needed to define the clinical role of such measurements and to explore potentials for active immunization, with PC as an antigen, or passive immunization, aiming at raising levels of protective anti-PC.
Carrero
Juan Jesús
JJ
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Hua
Xiang
X
Stenvinkel
Peter
P
Qureshi
Abdul Rashid
AR
Heimbürger
Olof
O
Bárány
Peter
P
Lindholm
Bengt
B
Frostegård
Johan
J
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010767:Phosphorylcholine / Q000276:immunology*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D012306:Risk
D007075:Immunoglobulin M; D015850:Interleukin-6; D010767:Phosphorylcholine