Study On Correlation Between Soluble Urokinase Plasminogen Activator Receptor With Coronary Artery Calcification And Cardiovascular Events And Mortality In Maintain Hemodialysis Patients

BackgroundIn recent years,the number of dialysis patients is increasing at an annual rate of 11%,maintain hemodialysis remains the chief way of renal replacement therapy.However,the incidence of death is 10-20 times greater in dialysis patients than general population of the same age,and it was confirmed that cardiovascular disease(CVD)accounts for more than 50 percent death.And coronary artery calcification is one of the important factor that result in high incidence and high death rate.Therefore,it is of vital clinical significance to screen practical markers which can predict cardiovascular disease in maintain hemodialysis patients.Now,it has become increasingly clear that inflammation plays a pivotal role in the development of atherosclerosis and CVD.Soluble urokinase plasminogen activator receptor(suPAR),a relatively new inflammatory biomarker.Previous studies showed an association between suPAR and CVD,type 1 and type 2 diabetes,Furthermore,suPAR appeared to be associated with coronary artery calcification(CAC)score independently of Systematic Coronary Risk Evaluation and provide prognostic information of CVD risk in the general population beyond the Framingham risk score.Given that suPAR is a prognostic marker in healthy populations and given the significant accumulation in patients with CKD,we questioned whether suPAR is of clinical relevance in maintain hemodialysis patients.We therefore studied associations between suPAR and CAC and clinical outcomes in maintain hemodialysis patients.ObjectiveTo investigate the associations between Soluble urokinase plasminogen activator receptor(suPAR)and coronary artery calcification and cardiovascular events and mortality in maintain hemodialysis patients.MethodsA total of 99 adult patients treated with maintain hemodialysis at Guangdong General Hospital were enrolled in this study during January 1st 2010 to June 1St 2015.The subjects' demographic characteristics and laboratorial examinations were collected as baseline data,including hemoglobin(Hb),serum calcium(Ca),serum phosphate(P),albumin(Alb),alkaline phosphatase(Alp),hsC-reactive(hs-CRP),intact parathyroid hormone(iPTH),history of cardiovascular.disease and so on.Plasma samples were analysed for suPAR by ELISA and coronary artery calcification(CAC)score was detected by MSCT.Occurrences of new on-set cardiovascular events and death were examined until 1st June 2016.The association of suPAR to CAC was evaluated by Bivariate and risk factors of mortality were identified with a multivariate COX proportional hazard model.ResultsUntil June 1 st 2016,the media observation was 33(22,58)months.Of the 99 MHD patients,91(91.9%)had varying degrees of CAC.SuPAR was found to positively correlate with CAC Score using Spearman analysis(P=0.001,r=0.315).In comparison with the cacs<100 group,suPAR was higher in the cacs?100 group(P=0.048).Quartiles of suPAR was employed as the cutoff point for subgroup analysis,the incidence of C VD and all-cause mortality were much higher in the higher quartiles of suPAR.In the univariate COX regression analysis,higher suPAR is a risk factor of CVD and all-cause mortality,[HR=2.573(1.708-3.876),P=0.025;2.806(1.139-6.195),P=0.025].In the COX proportional hazards model after adjustment for multi-factors,suPAR remained an independent factor of CVD,[HR=2.960(1.638?5.355),p<0.001].ConclusionsuPAR is associated with CAC score and show a clear,graded association with a higher risk for new on-set cardiovascular disease in MHD patients.