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Elevated serum soluble interleukin-2 receptor levels increase malignancy-related risk in patients on chronic hemodialysis

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Abstract

Background

Patients on chronic hemodialysis (HD) have an increased incidence of malignancy due to decreased immunity. Soluble interleukin-2 receptor (sIL-2R), as an immunomodulator, seemed to have an effect in the process of malignancy. In this study, we aimed to evaluate the clinical significance of increased sIL-2R in the course of malignancy among HD patients.

Methods

Patients who undergoing chronic hemodialysis were followed for 24 months. Risk factors for malignancy events and malignancy-related mortality during the 2-year follow-up period were investigated among various clinicopathological variables.

Results

Of the 363 patients included in this research, 47 patients (12.95%) had a prior history of treated malignancy. During the 2-year follow-up period, malignancy events were detected in 15 (4.12%) patients. Sixty-seven patients died during the study period, of which nine patients (13.43%) were died of malignancy. Malignancy events reduced 2-year mortality significantly (log-rank = 23.02, P < 0.0001). Both high sIL-2R levels ( ≥ 2-fold upper limit of the normal value) (OR 6.6, P = 0.006) and a prior history of treated malignancy (OR 4.12, P = 0.018)were identified by multivariate logistic analysis as independent determinants for malignancy events. However, only the levels of sIL-2R (used as a continuous variable) had the significantly predictive effect on malignancy events and malignancy-related mortality in the following 2 years.

Conclusions

Elevated sIL-2R levels was commonly seen in serum of HD patients. And this elevated level increased the risk of malignancy. Aside from its role as a biomarker, sIL-2R may also exert biological effects in the course of malignancy.

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Abbreviations

IL-2:

Interleukin-2

IL-2R:

Interleukin-2 receptor

sIL-2R:

Soluble interleukin-2 receptor

HD:

Hemodialysis

ESRD:

End-stage renal disease

CVD:

Cardiovascular disease

BMI:

Body-mass index

ESA:

Erythropoietin-stimulating agent

spKt/V:

Single-pooled Kt/V

TNF-α:

Tumor necrosis Factor α

RDW:

Red blood cell distribution width

hsCRP:

High-sensitivity C-reactive protein

AKP:

Alkaline phosphatase

GGT:

γ-Glutamyl transferase

LDH:

Lactate dehydrogenase

SCr:

Serum creatinine

UA:

Uric acid

β2-MG:

Beta-2-microglobulin

iPTH:

Intact parathyroid hormone

HbA1c:

Glycosylated hemoglobin

SD:

Standard deviation

IQR:

Interquartile range

ROC:

Receiver operating characteristic

OR:

Odds ratio

CI:

Confidence interval

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Funding

This study was founded by Shanghai Clinical Medical Center for Kidney Disease Project support by Shanghai Municipal Health Commission (no. 2017ZZ01015) and Shanghai Municipal Hospital Frontier Technology Project supported by Shanghai ShenKang Hospital Development Center (no. SHDC12018127).

Author information

Authors and Affiliations

  1. Shanghai Institute of Kidney and Dialysis, Shanghai, People’s Republic of China

    Chen XiaoHong, Shen Bo, Xiang FangFang, Guo Man, Zou JianZhou, Liu ZhongHua, Lv WenLv, Cao XueSen & Ding XiaoQiang

  2. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People’s Republic of China

    Chen XiaoHong, Shen Bo, Xiang FangFang, Guo Man, Zou JianZhou, Liu ZhongHua, Lv WenLv, Cao XueSen & Ding XiaoQiang

  3. Hemodialysis Quality Control Center of Shanghai, Shanghai, People’s Republic of China

    Chen XiaoHong, Shen Bo, Xiang FangFang, Guo Man, Zou JianZhou, Liu ZhongHua, Lv WenLv, Cao XueSen & Ding XiaoQiang

  4. Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China

    Chen XiaoHong, Shen Bo, Xiang FangFang, Guo Man, Zou JianZhou, Liu ZhongHua, Lv WenLv, Cao XueSen & Ding XiaoQiang

  5. Shanghai Medical Center of Kidney, Shanghai, People’s Republic of China

    Chen XiaoHong, Shen Bo, Xiang FangFang, Guo Man, Zou JianZhou, Liu ZhongHua, Lv WenLv, Cao XueSen & Ding XiaoQiang

  6. Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China

    Zhang Boheng

  7. Center for Evidence Based Medicine, Fudan University, Shanghai, People’s Republic of China

    Zhang Boheng

  8. Blood Purification Center, Zhongshan Hospital of Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, People’s Republic of China

    Ding XiaoQiang

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  1. Chen XiaoHong
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  2. Shen Bo
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  3. Xiang FangFang
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  4. Guo Man
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  5. Zou JianZhou
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  6. Liu ZhongHua
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  7. Lv WenLv
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  8. Cao XueSen
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  9. Ding XiaoQiang
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  10. Zhang Boheng
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Correspondence to Ding XiaoQiang.

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XiaoHong, C., Bo, S., FangFang, X. et al. Elevated serum soluble interleukin-2 receptor levels increase malignancy-related risk in patients on chronic hemodialysis. Int J Clin Oncol 24, 1151–1160 (2019). https://doi.org/10.1007/s10147-019-01455-5

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