title: Soluble CD40 ligand is predictive of combined cardiovascular morbidity and mortality in patients on haemodialysis at a relatively short-term follow-up.
abstract: BACKGROUND
  We tested the hypothesis that soluble CD40 ligand (sCD40L), a biomarker of proatherogenic inflammation, may be predictive of cardiovascular (CV) events in a subgroup of patients from the RISCAVID study, an observational and prospective study in patients on haemodialysis (HD).
  
  
  METHODS
  Plasma sCD40L levels were assessed at the time of the enrollment in 300 HD patients (mean age: 65 ± 15 years), recruited in five different centres. During a follow-up of 24 months, overall mortality, CV mortality and CV major nonfatal events (acute myocardial infarction, congestive heart failure and stroke) were registered. Cox proportional hazards regression assessed adjusted differences in CV morbidity and mortality risk.
  
  
  RESULTS
  Stratifying patients according to plasma sCD40L levels in those with levels lower or equal to (sCD40L-) and greater than (sCD40L+) the median value of 7.6 ng/mL, no significant difference was observed at baseline between the two groups in age, gender, blood pressure values and previous CV events. At 24-month follow-up, a significant (P < 0.01) lower incidence of the combined end point of CV morbidity and mortality was observed in the sCD40L- group (29%) as compared to the sCD40L+ group (36%). In the multivariate Cox proportional hazards regression model, the presence of sCD40L above the median value is associated with a significant increase in the risk of CV morbidity and mortality (hazard ratio: 1.61, 95% confidence interval 1.03-3.11).
  
  
  CONCLUSIONS
  These observational results support the prognostic value of sCD40L in end-stage renal disease, thus providing a useful tool to better stratify CV prognosis in these patients.
authors.affiliation: Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy. giovambattista.desideri@cc.univaq.it
authors.forename: Giovambattista
authors.initials: G
authors.lastname: Desideri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Panichi
authors.forename: Sabrina
authors.initials: S
authors.lastname: Paoletti
authors.forename: Davide
authors.initials: D
authors.lastname: Grassi
authors.forename: Roberto
authors.initials: R
authors.lastname: Bigazzi
authors.forename: Sara
authors.initials: S
authors.lastname: Beati
authors.forename: Giada
authors.initials: G
authors.lastname: Bernabini
authors.forename: Alberto
authors.initials: A
authors.lastname: Rosati
authors.forename: Claudio
authors.initials: C
authors.lastname: Ferri
authors.forename: Stefano
authors.initials: S
authors.lastname: Taddei
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ghiadoni
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D023201:CD40 Ligand / Q000097:blood*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008297:Male; D009017:Morbidity; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D018570:Risk Assessment; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D023201:CD40 Ligand; D002097:C-Reactive Protein