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2015 ; 10
(3
): e0122073
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Soluble tumor necrosis factor receptor 1 and 2 predict outcomes in advanced
chronic kidney disease: a prospective cohort study
#MMPMID25823004
Neirynck N
; Glorieux G
; Schepers E
; Verbeke F
; Vanholder R
PLoS One
2015[]; 10
(3
): e0122073
PMID25823004
show ga
BACKGROUND: Soluble tumor necrosis factor receptors 1 (sTNFR1) and 2 (sTNFR2)
have been associated to progression of renal failure, end stage renal disease and
mortality in early stages of chronic kidney disease (CKD), mostly in the context
of diabetic nephropathy. The predictive value of these markers in advanced stages
of CKD irrespective of the specific causes of kidney disease has not yet been
defined. In this study, the relationship between sTNFR1 and sTNFR2 and the risk
for adverse cardiovascular events (CVE) and all-cause mortality was investigated
in a population with CKD stage 4-5, not yet on dialysis, to minimize the
confounding by renal function. PATIENTS AND METHODS: In 131 patients, CKD stage
4-5, sTNFR1, sTNFR2 were analysed for their association to a composite endpoint
of all-cause mortality or first non-fatal CVE by univariate and multivariate Cox
proportional hazards models. In the multivariate models, age, gender, CRP, eGFR
and significant comorbidities were included as covariates. RESULTS: During a
median follow-up of 33 months, 40 events (30.5%) occurred of which 29 deaths
(22.1%) and 11 (8.4%) first non-fatal CVE. In univariate analysis, the hazard
ratios (HR) of sTNFR1 and sTNFR2 for negative outcome were 1.49 (95% confidence
interval (CI): 1.28-1.75) and 1.13 (95% CI: 1.06-1.20) respectively. After
adjustment for clinical covariables (age, CRP, diabetes and a history of
cardiovascular disease) both sTNFRs remained independently associated to outcomes
(HR: sTNFR1: 1.51, 95% CI: 1.30-1.77; sTNFR2: 1.13, 95% CI: 1.06-1.20). A
subanalysis of the non-diabetic patients in the study population confirmed these
findings, especially for sTNFR1. CONCLUSION: sTNFR1 and sTNFR2 are independently
associated to all-cause mortality or an increased risk for cardiovascular events
in advanced CKD irrespective of the cause of kidney disease.
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Biomarkers/metabolism
[MESH]
|Cardiovascular Diseases/metabolism
[MESH]
|Disease Progression
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Male
[MESH]
|Middle Aged
[MESH]
|Proportional Hazards Models
[MESH]
|Prospective Studies
[MESH]
|Receptors, Tumor Necrosis Factor, Type I/*metabolism
[MESH]
|Receptors, Tumor Necrosis Factor, Type II/*metabolism
[MESH]