title: Complement and Cardiovascular Disease--The Missing Link in Haemodialysis Patients.
abstract: BACKGROUND
  Patients on haemodialysis (HD) have high rates of cardiovascular (CV) disease and activation of the complement system. Despite evidence in non-renal patients that these may be linked, this association has received little attention in HD patients to date. In the setting of a randomised controlled trial we evaluated the relationships between baseline complement levels and subsequent CV events and mortality, in addition to the effects of HD with a vitamin E (VE)-coated dialysis membrane on circulating complement levels.
  
  
  METHODS
  A total of 260 HD patients were randomised to dialysis with a VE-coated dialysis membrane or non-VE coated equivalent for 12 months. Blood samples were taken at baseline, 6 and 12 months for measurement of C3, factor D, factor H and SC5b-9 levels. Data were collected prospectively on deaths and CV events.
  
  
  RESULTS
  Higher C3 levels at baseline were associated with subsequent CV events (hazard ratio 1.20 (1.01-1.42) per 0.1 mg/ml). Patients with intermediate SC5b-9 levels had significantly lower CV event rates and mortality than those with either high or low levels (p < 0.01). There were no effects of the VE-membranes on the complement components measured nor the clinical endpoints considered.
  
  
  CONCLUSIONS
  The levels of C3 and SC5b-9 may have prognostic utility for predicting future CV events and/or mortality in HD patients - a relationship that requires further investigation. Dialysing prevalent HD patients with VE-bonded polysulfone membranes for a period of 12 months did not alter the circulating levels of the alternative complement pathway components considered here.
authors.affiliation: Department of Renal Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Lines
authors.forename: Victoria R
authors.initials: VR
authors.lastname: Richardson
authors.forename: Bryn
authors.initials: B
authors.lastname: Thomas
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Dunn
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Wright
authors.forename: Angela M
authors.initials: AM
authors.lastname: Carter
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000378:metabolism*; D003176:Complement C3 / Q000378:metabolism; D011416:Complement Factor D / Q000378:metabolism; D017242:Complement Factor H / Q000378:metabolism; D015938:Complement Membrane Attack Complex / Q000235:genetics / Q000378:metabolism; D003165:Complement System Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000378:metabolism* / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D014810:Vitamin E
chemical_list: D003176:Complement C3; D015938:Complement Membrane Attack Complex; D008567:Membranes, Artificial; C047610:SC5b-9 protein complex; D014810:Vitamin E; D017242:Complement Factor H; D003165:Complement System Proteins; D011416:Complement Factor D