Journal Article

Soluble adhesion molecules in end-stage renal disease: a predictor of outcome

Mohamed E. Suliman, A. Rashid Qureshi, Olof Heimbürger, Bengt Lindholm and Peter Stenvinkel

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 21, issue 6, pages 1603-1610
Published in print June 2006 | ISSN: 0931-0509
Published online February 2006 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfl005
Soluble adhesion molecules in end-stage renal disease: a predictor of outcome

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Background. Inflammation is thought to contribute to initiation and aggravation of atherosclerosis through a process predominantly mediated by adhesion molecules. The aims of this study were to investigate the association between the concentrations of circulating soluble intercellular (sICAM-1) and vascular cellular (sVCAM-1) adhesion molecules and clinical outcome, and to evaluate the effect of antihypertensive drugs on sICAM-1 and sVCAM-1 concentrations in end-stage renal disease (ESRD) patients.

Methods. We prospectively investigated 310 (191 males) incident ESRD patients, 53±12 years old, shortly before the start of renal replacement therapy. Glomerular filtration rate (GFR) was 6.4 (range 0.8–16.5) ml/min/1.73 m2. Plasma sICAM-1 and sVCAM-1 were measured by enzyme-linked immunosorbent assay (ELISA) kits. Survival was determined from the day of examination, with a mean follow-up period of 39 (range 1–123) months.

Results. In non-adjusted analysis, high sICAM-1 and sVCAM-1 levels were associated with all-cause and cardiovascular (P<0.001) mortality. After adjusting for age, gender, diabetes mellitus, serum cholesterol, C-reactive protein (CRP), subjective global assessment and angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), the association between high sICAM-1 and mortality remained significant for all-cause (HR 1.9; CI 1.2–2.9, P = 0.004) and cardiovascular (HR 1.8; CI 1.1–3.1, P = 0.02) mortality, and a high sVCAM-1 was associated with all-cause mortality (HR 1.7; CI 1.04–2.7, P = 0.03). Furthermore, the concentration of sICAM-1, but not sVCAM-1, was lower in patients receiving ACEI/ARB (254±83 vs 275±92 ng/ml; P<0.05) or patients receiving calcium channel blockers (CCB, 251±75 vs 273±95 ng/ml; P<0.05) than in non-users.

Conclusions. In ESRD patients, sICAM-1 and sVCAM-1 are independent predictors of all cause and cardiovascular death. The use of ACEI/ARB or CCB was associated with decreased concentrations of soluble adhesion molecules.

Keywords: angiotensin-converting enzyme inhibitors; cardiovascular disease; end-stage renal disease; inflammation; mortality; soluble adhesion molecules

Journal Article.  4211 words.  Illustrated.

Subjects: Nephrology

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