Deficiency of circulating progenitor cells associated with vascular thrombosis of hemodialysis patients.
Hemodialysis (HD) patients have an increased risk of thrombosis. Endothelial progenitor cells (EPCs), which function in vascular repair, are deficient in HD patients. Nonetheless, the relationship between EPC deficiency and thrombosis in HD patients is unknown.



From January 2010 to December 2012, circulating levels of EPCs that were positive for CD34 and kinase insert domain receptor (KDR) were measured in 269 HD patients. Patients received prospective follow-ups at 6-month intervals until May 2015. The primary outcome was the composite of HD access thrombosis and systemic vascular thrombosis.



There were 141 thrombotic events, 50 systemic vascular thrombotic events and 116 HD access thrombotic events. We found significantly negative associations between CD34 +  KDR +  tertile and overall thrombotic events (low: 61%; middle: 56%; high: 40%; P = 0.02), systemic vascular thrombotic events (low: 27%; middle: 18%; high: 10%; P = 0.03) and HD access thrombotic events (low: 52%; middle: 46%; high: 36%; P = 0.02). Univariate analysis indicated that systemic vascular thrombotic events were positively associated with age, diabetes, dyslipidemia, vascular disease history, urea clearance, albumin and C-reactive protein (CRP), and negatively associated with CD34 +  KDR +  cell count. HD access thrombosis was positively associated with vascular disease history and CRP, and negatively associated with CD34 +  KDR +  cell count. Multivariate analysis indicated that a low CD34 +  KDR +  cell count was an independent risk factor for both types of thrombosis.



Our study of a population of HD patients showed that a low level of circulating EPCs is associated with thrombosis.
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.|College of Medicine, National Taiwan University, Taipei, Taiwan.
Mu-Yang
MY
Hsieh
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
Tsung-Yan
TY
Chen
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
Lin
L
Lin
Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
Shao-Yuan
SY
Chuang
Shing-Jong
SJ
Lin
Institutes of Physiology and Clinical Medicine, Genome Research and Infection and Immunity Centers, National Yang-Ming University, Taipei, Taiwan.|Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Der-Cheng
DC
Tarng
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.|Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Po-Hsun
PH
Huang
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.|College of Medicine, National Taiwan University, Taipei, Taiwan.|Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chih-Cheng
CC
Wu
D000368:Aged; D000369:Aged, 80 and over; D018952:Antigens, CD34 / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002452:Cell Count; D066026:Endothelial Progenitor Cells / Q000166:cytology* / Q000378:metabolism; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000453:epidemiology*; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000378:metabolism
D018952:Antigens, CD34; D002097:C-Reactive Protein; D040301:Vascular Endothelial Growth Factor Receptor-2
end-stage renal disease; endothelial progenitor cells; hemodialysis; thrombosis