Prognostic value of plasma myeloperoxidase in ESRD patients.
BACKGROUND
Myeloperoxidase (MPO) has been suggested to have a role in atherosclerosis through its strong oxidative capacity. We hypothesized that MPO level may predict clinical outcomes in patients with end-stage renal disease receiving long-term peritoneal dialysis (PD) therapy.


METHODS
Prospective cohort study.


METHODS
236 long-term PD patients were recruited from a single regional dialysis unit in Hong Kong between April 1999 and February 2001.


METHODS
Level of plasma MPO, analyzed using a sandwich enzyme-linked immunosorbent assay.


METHODS
Mortality and fatal or nonfatal cardiovascular events at 3 years.


RESULTS
The distribution of MPO levels was skewed with a median of 31.8 μg/L (25th-75th percentiles, 24.4-42.7). There were 69 deaths and 81 cardiovascular events. Adjusting for traditional and nontraditional risk factors and C-reactive protein, cardiac troponin T, and N-terminal pro-brain natriuretic peptide levels, a doubling in plasma MPO level was associated independently with a 46% (95% CI, 1.02-2.08; P = 0.04) and 60% (95% CI, 1.17-2.18; P = 0.003) increase in risks of mortality and cardiovascular events, respectively. Log(2)MPO showed significant additional predictive value for mortality (P = 0.04) and cardiovascular events (P = 0.005) when included in Cox regression models consisting of clinical, demographic, dialysis, echocardiographic, and biochemical parameters, as well as C-reactive protein, cardiac troponin T, and N-terminal pro-brain natriuretic peptide levels.


CONCLUSIONS
MPO was measured at a single time and did not reflect changes over time.


CONCLUSIONS
These data suggest that plasma MPO level has significant independent and additional prognostic value beyond the standard clinical, biochemical, and echocardiographic parameters and is useful for outcome stratification in long-term PD patients. MPO may be an important mediator of increased cardiovascular risk in patients with end-stage renal disease and warrants further investigation.
Wang
Angela Yee-Moon
AY
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. aymwang@hku.hk
Lam
Christopher Wai-Kei
CW
Chan
Iris Hiu-Shuen
IH
Wang
Mei
M
Lui
Siu-Fai
SF
Sanderson
John E
JE
D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000201:enzymology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology; D010530:Peritoneal Dialysis; D009195:Peroxidase / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
D009195:Peroxidase