Role of High-sensitivity C-reactive Protein in Future Cardiovascular Events in Hemodialysis Patients

Overview

Journal In Vivo

Specialty Oncology

Date 2024 Apr 30

PMID 38688654

Authors

Hiroshi Osawa

Norio Nakamura

Chikako Tsutaya

Hisao Saitoh

Michiko Shimada

Reiichi Murakami

Takeshi Fujita

Ikuyo Narita-Kinjo

Daiki Nagawa

Masamichi Nakata

Takashi Yokota

Chikara Ohyama

Hirofumi Tomita

Affiliations

Soon will be listed here.

Abstract

Background/aim: The pathogenesis of cardio-vascular disease (CVD) in hemodialysis (HD) patients involves inflammation and oxidative stress. High-sensitivity C-reactive protein (hs-CRP) is an established inflammatory biomarker associated with CVD. Several studies have suggested that the inflammatory biomarker pentraxin-3 (PTX-3) and the oxidative stress-related biomarker soluble lectin-like low-density lipoprotein receptor-1 (sLOX-1) are novel biomarkers for CVD in non-HD populations. This study aimed to clarify the association of these established and novel biomarkers with future cardiovascular (CV) events in HD patients.

Patients And Methods: This was a single-center prospective cohort study that included 255 HD patients. The primary outcome was the composite of nonfatal and fatal CV events. The event-free survival rate between the two groups according to the median plasma level of each biomarker at baseline was evaluated using the Kaplan-Meier method. The risk for CV events at elevated levels of each biomarker was estimated using Cox proportional hazard model.

Results: We observed 44 CV events during the median follow-up period of 743 days. The event-free survival rate significantly differed between the two groups in hs-CRP but not in PTX-3 or sLOX-1. The unadjusted hazard ratio (HR) for CV events in patients with hs-CRP levels above the median was 2.63 [95% confidence interval (CI)=1.37-5.02]. The HR remained significant after adjusting for age, sex, history of CVD, and diabetes (HR=2.30; 95%CI=1.20-4.43).

Conclusion: In HD patients, hs-CRP may have a predictable role for future CV events, whereas PTX-3 and sLOX-1 do not.

Citing Articles

Exploring the Associations Between Inflammatory Biomarkers, Survival, and Cardiovascular Events in Hemodialysis Patients and the Interrelationship with Nutritional Parameters-The Experience of a Single Transylvanian Dialysis Center.

Rusu C, Kacso I, Moldovan D, Potra A, Tirinescu D, Ticala M J Clin Med. 2025; 14(4).

PMID: 40004669 PMC: 11855970. DOI: 10.3390/jcm14041139.

References

Besli F, Gullulu S, Sag S, Kecebas M, Acikgoz E, Sarandol E . The relationship between serum lectin-like oxidized LDL receptor-1 levels and systolic heart failure. Acta Cardiol. 2016; 71(2):185-90. DOI: 10.2143/AC.71.2.3141848. View

Li Y, Zhong X, Cheng G, Zhao C, Zhang L, Hong Y . Hs-CRP and all-cause, cardiovascular, and cancer mortality risk: A meta-analysis. Atherosclerosis. 2017; 259:75-82. DOI: 10.1016/j.atherosclerosis.2017.02.003. View

Guo X, Xiang Y, Yang H, Yu L, Peng X, Guo R . Association of the LOX-1 rs1050283 Polymorphism with Risk for Atherosclerotic Cerebral Infarction and its Effect on sLOX-1 and LOX-1 Expression in a Chinese Population. J Atheroscler Thromb. 2016; 24(6):572-582. PMC: 5453683. DOI: 10.5551/jat.36327. View

Igari K, Kudo T, Toyofuku T, Inoue Y . Relationship of Inflammatory Biomarkers with Severity of Peripheral Arterial Disease. Int J Vasc Med. 2016; 2016:6015701. PMC: 4983378. DOI: 10.1155/2016/6015701. View

Nagai K, Ueda A, Saito C, Zempo-Miyaki A, Yamagata K . Annual decline in pentraxin 3 is a risk of vascular access troubles in hemodialysis patients. Int J Nephrol. 2015; 2014:297954. PMC: 4283416. DOI: 10.1155/2014/297954. View

Kobayashi N, Takano M, Hata N, Kume N, Yamamoto M, Yokoyama S . Soluble lectin-like oxidized LDL receptor-1 (sLOX-1) as a valuable diagnostic marker for rupture of thin-cap fibroatheroma: verification by optical coherence tomography. Int J Cardiol. 2013; 168(4):3217-23. DOI: 10.1016/j.ijcard.2013.04.110. View

Kimura S, Inagaki H, Haraguchi G, Sugiyama T, Miyazaki T, Hatano Y . Relationships of elevated systemic pentraxin-3 levels with high-risk coronary plaque components and impaired myocardial perfusion after percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction. Circ J. 2013; 78(1):159-69. DOI: 10.1253/circj.cj-13-0329. View

Panichi V, Migliori M, De Pietro S, Metelli M, Taccola D, Perez R . Plasma C-reactive protein in hemodialysis patients: a cross-sectional, longitudinal clinical survey. Blood Purif. 2000; 18(1):30-6. DOI: 10.1159/000014405. View

Navarra T, Del Turco S, Berti S, Basta G . The lectin-like oxidized low-density lipoprotein receptor-1 and its soluble form: cardiovascular implications. J Atheroscler Thromb. 2009; 17(4):317-31. DOI: 10.5551/jat.3228. View

10.

Suliman M, Qureshi A, Carrero J, Barany P, Yilmaz M, Snaedal-Jonsdottir S . The long pentraxin PTX-3 in prevalent hemodialysis patients: associations with comorbidities and mortality. QJM. 2008; 101(5):397-405. DOI: 10.1093/qjmed/hcn019. View

11.

Mantovani A, Garlanda C, Bottazzi B, Peri G, Doni A, Martinez De La Torre Y . The long pentraxin PTX3 in vascular pathology. Vascul Pharmacol. 2006; 45(5):326-30. DOI: 10.1016/j.vph.2006.08.011. View

12.

Apple F, Murakami M, Pearce L, Herzog C . Multi-biomarker risk stratification of N-terminal pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and cardiac troponin T and I in end-stage renal disease for all-cause death. Clin Chem. 2004; 50(12):2279-85. DOI: 10.1373/clinchem.2004.035741. View

13.

Norata G, Marchesi P, Venu V, Pasqualini F, Anselmo A, Moalli F . Deficiency of the long pentraxin PTX3 promotes vascular inflammation and atherosclerosis. Circulation. 2009; 120(8):699-708. DOI: 10.1161/CIRCULATIONAHA.108.806547. View

14.

Makita S, Nakamura M, Satoh K, Tanaka F, Onoda T, Kawamura K . Serum C-reactive protein levels can be used to predict future ischemic stroke and mortality in Japanese men from the general population. Atherosclerosis. 2008; 204(1):234-8. DOI: 10.1016/j.atherosclerosis.2008.07.040. View

15.

Jenny N, Blumenthal R, Kronmal R, Rotter J, Siscovick D, Psaty B . Associations of pentraxin 3 with cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. J Thromb Haemost. 2014; 12(6):999-1005. PMC: 4055511. DOI: 10.1111/jth.12557. View

16.

Inoue N, Okamura T, Kokubo Y, Fujita Y, Sato Y, Nakanishi M . LOX index, a novel predictive biochemical marker for coronary heart disease and stroke. Clin Chem. 2010; 56(4):550-8. DOI: 10.1373/clinchem.2009.140707. View

17.

Sawamura T, Wakabayashi I, Okamura T . LOX-1 in atherosclerotic disease. Clin Chim Acta. 2014; 440:157-63. DOI: 10.1016/j.cca.2014.11.016. View

18.

Inoue K, Kodama T, Daida H . Pentraxin 3: a novel biomarker for inflammatory cardiovascular disease. Int J Vasc Med. 2012; 2012:657025. PMC: 3278926. DOI: 10.1155/2012/657025. View

19.

Kono K, Fujii H, Miyoshi N, Kawamori H, Shite J, Hirata K . Coronary plaque morphology using virtual histology-intravascular ultrasound analysis in hemodialysis patients. Ther Apher Dial. 2011; 15(1):44-50. DOI: 10.1111/j.1744-9987.2010.00855.x. View

20.

Arima H, Kubo M, Yonemoto K, Doi Y, Ninomiya T, Tanizaki Y . High-sensitivity C-reactive protein and coronary heart disease in a general population of Japanese: the Hisayama study. Arterioscler Thromb Vasc Biol. 2008; 28(7):1385-91. DOI: 10.1161/ATVBAHA.107.157164. View