title: Endothelial dysfunction, inflammation and malnutrition markers as predictors of mortality in dialysis patients: multimarker approach.
abstract: BACKGROUND
  Cardiovascular disease is reported to be major cause of mortality in dialysis patients. Multimarker approach is new approach in risk stratification. Creating a common predictive value, many different pathophysiological components are covered. The aim of this study was to examine the combined predictive value of markers of endothelial dysfunction (ADMA), inflammation (CRP, SAA) and malnutrition (albumin) in dialysis patients.
  
  
  METHODS
  In this prospective 3-year follow-up study, 153 prevalent patients (105 males and 48 females) on hemodialysis were included. ADMA were measured by HPLC; CRP and SAA were measured using immunonephelometric assays. Albumins were measured by the use of standard methods on the automated analyzer. The patients were stratified into five groups based on the presence of 1, 2, and 3 or more risk markers, respectively, namely high ADMA (≥0.49 μmol/L), high CRP (≥6.0 mg/L), high SAA (≥7.6 mg/L) and low albumin (<30.3 g/L).
  
  
  RESULTS
  The patients with 1, 2, 3 or more risk markers had an adjusted hazard ratio (HR) of 2.419 (0.728-8.034), 6.720 (2.100-21.503), 10.455 (3.193-24.227), respectively, for mortality, compared to those without risk markers. The patients with 1, 2, 3 or more risk markers had an adjusted HR of 1.838 (0.307-11.006), 9.924 (2.052-28.003), 14.823 (0.2.962-34.189), respectively, for cardiovascular mortality than those without risk markers.
  
  
  CONCLUSIONS
  The results of this study demonstrate that the common predictive value of several markers is higher than individual predictive value of examined risk factors. Patients with multiple risk factors had higher mortality. Multimarker approach provides an opportunity for better risk stratification in dialysis patients.
authors.affiliation: Department of Medical Statistics, Faculty of Medicine Niš, University of Niš, Boulevard Zorana Djindjica 81, 18000, Nis, Serbia, drsalea@yahoo.com.
authors.forename: Aleksandra M
authors.initials: AM
authors.lastname: Ignjatović
authors.forename: Tatjana P
authors.initials: TP
authors.lastname: Cvetković
authors.forename: Radmila M
authors.initials: RM
authors.lastname: Pavlović
authors.forename: Vidojko M
authors.initials: VM
authors.lastname: Đorđević
authors.forename: Zoran G
authors.initials: ZG
authors.lastname: Milošević
authors.forename: Vidosava B
authors.initials: VB
authors.lastname: Đorđević
authors.forename: Dušica D
authors.initials: DD
authors.lastname: Pavlović
authors.forename: Ivana R
authors.initials: IR
authors.lastname: Stojanović
authors.forename: Dragan
authors.initials: D
authors.lastname: Bogdanović
mesh_terms: D000328:Adult; D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000097:blood; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis / Q000401:mortality; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism; D000685:Serum Amyloid A Protein / Q000378:metabolism
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D000685:Serum Amyloid A Protein; C018524:N,N-dimethylarginine; D002097:C-Reactive Protein; D001120:Arginine