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Endothelial dysfunction, inflammation and malnutrition markers as predictors of mortality in dialysis patients: multimarker approach

  • Nephrology - Original Paper
  • Published:
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Abstract

Backgrounds

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.

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Abbreviations

ADMA:

Asymmetric dimethylarginine

DDAH:

Dimethyl-aminohydrolase

CRP:

C-reactive protein

SAA:

Serum amyloid

CVD:

Cardiovascular

HPLC:

High-performance liquid chromatography

ΟPA:

Precolumn derivatization with ο-phthaldialdehyde

HR:

Hazard ratio

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Acknowledgments

This study was supported by a research grant from the Serbian Ministry of Science and Technological Development—project number 41018. The study was approved by the local ethics committee, and all patients provided informed consent. All authors are in agreement with the content of this manuscript.

Conflict of interest

The authors declare they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Medical Statistics, Faculty of Medicine Niš, University of Niš, Boulevard Zorana Djindjica 81, 18000, Nis, Serbia

    Aleksandra M. Ignjatović & Zoran G. Milošević

  2. Faculty of Medicine Niš, Research Centre for Biomedicine, University of Niš, Boulevard Zorana Djindjica 81, 18000, Nis, Serbia

    Aleksandra M. Ignjatović & Radmila M. Pavlović

  3. Institute of Biochemistry, Faculty of Medicine Niš, University of Niš, Boulevard Zorana Djindjica 81, 18000, Nis, Serbia

    Tatjana P. Cvetković, Vidosava B. Đorđević, Dušica D. Pavlović & Ivana R. Stojanović

  4. Clinic of Nephrology, Clinical Centre Niš, Boulevard Zorana Djindjica 48, 18000, Nis, Serbia

    Tatjana P. Cvetković & Vidojko M. Đorđević

  5. Department of Biomedical Sciences, State University of Novi Pazar, Vuka Karadzica bb, 36300, Novi Pazar, Serbia

    Dragan Bogdanović

Authors
  1. Aleksandra M. Ignjatović
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  2. Tatjana P. Cvetković
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  3. Radmila M. Pavlović
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Correspondence to Aleksandra M. Ignjatović.

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Ignjatović, A.M., Cvetković, T.P., Pavlović, R.M. et al. Endothelial dysfunction, inflammation and malnutrition markers as predictors of mortality in dialysis patients: multimarker approach. Int Urol Nephrol 45, 1715–1724 (2013). https://doi.org/10.1007/s11255-013-0439-6

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  • DOI: https://doi.org/10.1007/s11255-013-0439-6

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