背景:确定慢性肾脏病(CKD)死亡率生物标志物的重要性,尤其是在接受血液透析(HD)治疗的患者中,已经变得明显。除了是肾小管间质损伤的标志,血浆肾损伤分子-1(KIM-1)被认为是HD患者心血管疾病(CV)死亡率和冠状动脉钙化的危险标志物.这项研究的目的是评估血浆KIM-1水平作为CKD5-HD患者(接受血液透析治疗的CKDG5D阶段患者)的心血管疾病(CVD)和死亡率的标志物。
方法:我们进行了一项前瞻性病例对照研究,包括63例CKD5-HD患者(HD1-5年),随访48个月,对照组包括52例非透析患者,诊断为CKD分期G1-G5(ND-CKD)。所有患者均有CVD基线评估,包括病史,超声心动图,心电图(ECG)。循环血浆KIM-1水平通过单分子计数免疫测定技术使用酶联免疫吸附测定来确定。我们获得了以下参数:血清肌酐和尿素;炎症标志物CRP(C反应蛋白)和IL-6(白细胞介素-6);和贫血标志物全血细胞计数,血清铁蛋白,和转铁蛋白饱和度(TSAT)。
结果:平均血浆KIM-1水平为403.8±546.8pg/mL,显示与炎症有统计学意义的相关性(CRP,R=0.28,p=0.02;IL-6,R=0.36,p=0.005)和贫血(血细胞比容,R=-0.5,p=-0.0316;血红蛋白(Hb),R=-0.5,p=0.02)。我们发现,超声心动图检查的左心室肥厚(LVH)患者(59.7%)的血浆KIM-1平均水平明显低于对照组(155.51vs.432.12pg/mL;p=0.026)。关于患者的随访,我们评估了全因死亡率作为终点.经过24个月的随访,我们发现死亡率为22.23%,48个月后,死亡率为50.73%。血浆KIM-1水平<82.98pg/mL与血液透析患者生存率降低显著相关(p<0.001)。
结论:在接受血液透析治疗的患者中,低水平的血浆KIM-1与心血管变化和死亡风险增加相关.HD患者的血浆KIM-1水平显著高于ND-CKD患者。
BACKGROUND: The importance of identifying mortality biomarkers in chronic kidney disease (CKD), and especially in patients treated with hemodialysis (HD), has become evident. In addition to being a marker of tubulointerstitial injury, plasma kidney injury molecule-1 (KIM-1) has been mentioned in regard to HD patients as a risk marker for cardiovascular (CV) mortality and coronary artery calcification. The aim of this study was to assess the level of plasma KIM-1 as a marker of cardiovascular disease (CVD) and mortality in CKD5-HD patients (patients with CKD stage G5D treated with hemodialysis).
METHODS: We conducted a prospective case-control study that included 63 CKD5-HD patients (HD for 1-5 years) followed up for 48 months and a control group consisting of 52 non-dialysis patients diagnosed with CKD stages G1-G5 (ND-CKD). All patients had a CVD baseline assessment including medical history, echocardiography, and electrocardiography (ECG). Circulating plasma KIM-1 levels were determined with single-molecule counting immunoassay technology using an enzyme-linked immunosorbent assay. We obtained the following parameters: serum creatinine and urea; the inflammation markers CRP (C-reactive protein) and IL-6 (interleukin-6); and the anemia markers complete blood count, serum ferritin, and transferrin saturation (TSAT).
RESULTS: The mean plasma KIM-1 level was 403.8 ± 546.8 pg/mL, showing a statistically significant correlation with inflammation (CRP, R = 0.28, p = 0.02; IL-6, R = 0.36, p = 0.005) and with anemia (hematocrit, R = -0.5, p = -0.0316; hemoglobin (Hb), R = -0.5, p = 0.02). We found that patients with left ventricular hypertrophy (LVH) on echocardiography (59.7%) had significantly lower mean levels of plasma KIM-1 than patients from the control group (155.51 vs. 432.12 pg/mL; p = 0.026). Regarding the patients\' follow-up, we assessed all-cause mortality as an endpoint. After 24 months of follow-up, we found a mortality rate of 22.23%, while after 48 months, the mortality rate was 50.73%. A plasma KIM-1 level < 82.98 pg/mL was significantly associated with decreased survival in hemodialysis patients (p < 0.001).
CONCLUSIONS: In patients treated with hemodialysis, low levels of plasma KIM-1 were associated with cardiovascular changes and an increased risk of mortality. Plasma KIM-1 levels were significantly higher in HD patients compared to ND-CKD patients.