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Article: Long-term mortality and cardiovascular risk stratification of peritoneal dialysis patients using a combination of inflammation and calcification markers

TitleLong-term mortality and cardiovascular risk stratification of peritoneal dialysis patients using a combination of inflammation and calcification markers
Authors
Issue Date2009
PublisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/
Citation
Nephrology Dialysis Transplantation, 2009, v. 24 n. 12, p. 3826-3833 How to Cite?
AbstractBackground. It remains unknown whether a composite of inflammation and calcification markers provides better mortality and cardiovascular risk stratification in chronic peritoneal dialysis (PD) patients.Methods. We performed a 4-year prospective follow-up study in 231 chronic PD patients from a single regional dialysis centre in Hong Kong. Valvular calcification was detected using echocardiography, and fasting venous blood was collected to measure a panel of inflammation markers. The patients were stratified into five groups on the basis of 0, 1, 2, 3 and all 4 inflammation and calcification risk markers, namely high C-reactive protein (CRP) (CRP in upper tertile), high interleukin-6 (IL-6) (IL-6 in upper tertile), low fetuin-A (fetuin-A in lower tertile) and valvular calcification. Study outcomes included all-cause and cardiovascular mortality and fatal or non-fatal cardiovascular events (CVEs).Results. The patients with 4, 3, 2 and 1 markers had an adjusted hazard ratio (HR) of 5.17 (95 CI, 1.81-14.77, P = 0.002), 3.38 (95 CI, 1.50-7.60; P = 0.003), 2.17 (95 CI, 0.98-4.77; P = 0.056) and 2.42 (95 CI, 1.18-4.96; P = 0.016), respectively, for mortality at 4 years than those with 0 risk marker. The adjusted HRs for fatal or non-fatal CVEs were 4.33 (95 CI, 1.70-11.03; P = 0.002), 1.60 (95 CI, 0.73-3.52; P = 0.24), 1.92 (95 CI, 0.95-3.90; P = 0.07) and 1.33 (95 CI, 0.67-2.62; P = 0.42), respectively, for patients with 4, 3, 2 and 1 markers than those with 0 risk markers.Conclusions. A composite of inflammation and calcification markers provides long-term prognostication and identifies the sickest PD patients with the worst clinical outcomes. Since these parameters can all be obtained quite readily, our data support the adoption of a multiinflammation and calcification risk marker approach for mortality and cardiovascular risk stratification in PD patients.
Persistent Identifierhttp://hdl.handle.net/10722/163285
ISSN
2015 Impact Factor: 4.085
2015 SCImago Journal Rankings: 1.780
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWang, AYMen_US
dc.contributor.authorLam, CWKen_US
dc.contributor.authorChan, IHSen_US
dc.contributor.authorWang, Men_US
dc.contributor.authorLui, SFen_US
dc.contributor.authorSanderson, JEen_US
dc.date.accessioned2012-09-05T05:29:37Z-
dc.date.available2012-09-05T05:29:37Z-
dc.date.issued2009en_US
dc.identifier.citationNephrology Dialysis Transplantation, 2009, v. 24 n. 12, p. 3826-3833en_US
dc.identifier.issn0931-0509en_US
dc.identifier.urihttp://hdl.handle.net/10722/163285-
dc.description.abstractBackground. It remains unknown whether a composite of inflammation and calcification markers provides better mortality and cardiovascular risk stratification in chronic peritoneal dialysis (PD) patients.Methods. We performed a 4-year prospective follow-up study in 231 chronic PD patients from a single regional dialysis centre in Hong Kong. Valvular calcification was detected using echocardiography, and fasting venous blood was collected to measure a panel of inflammation markers. The patients were stratified into five groups on the basis of 0, 1, 2, 3 and all 4 inflammation and calcification risk markers, namely high C-reactive protein (CRP) (CRP in upper tertile), high interleukin-6 (IL-6) (IL-6 in upper tertile), low fetuin-A (fetuin-A in lower tertile) and valvular calcification. Study outcomes included all-cause and cardiovascular mortality and fatal or non-fatal cardiovascular events (CVEs).Results. The patients with 4, 3, 2 and 1 markers had an adjusted hazard ratio (HR) of 5.17 (95 CI, 1.81-14.77, P = 0.002), 3.38 (95 CI, 1.50-7.60; P = 0.003), 2.17 (95 CI, 0.98-4.77; P = 0.056) and 2.42 (95 CI, 1.18-4.96; P = 0.016), respectively, for mortality at 4 years than those with 0 risk marker. The adjusted HRs for fatal or non-fatal CVEs were 4.33 (95 CI, 1.70-11.03; P = 0.002), 1.60 (95 CI, 0.73-3.52; P = 0.24), 1.92 (95 CI, 0.95-3.90; P = 0.07) and 1.33 (95 CI, 0.67-2.62; P = 0.42), respectively, for patients with 4, 3, 2 and 1 markers than those with 0 risk markers.Conclusions. A composite of inflammation and calcification markers provides long-term prognostication and identifies the sickest PD patients with the worst clinical outcomes. Since these parameters can all be obtained quite readily, our data support the adoption of a multiinflammation and calcification risk marker approach for mortality and cardiovascular risk stratification in PD patients.en_US
dc.languageengen_US
dc.publisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/en_US
dc.relation.ispartofNephrology Dialysis Transplantationen_US
dc.subject.meshCalcinosis - Blooden_US
dc.subject.meshCardiovascular Diseases - Blood - Diagnosis - Epidemiology - Etiologyen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHumansen_US
dc.subject.meshInflammation - Blooden_US
dc.subject.meshKidney Failure, Chronic - Blood - Complications - Mortality - Therapyen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPeritoneal Dialysisen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshRisk Assessmenten_US
dc.subject.meshTime Factorsen_US
dc.titleLong-term mortality and cardiovascular risk stratification of peritoneal dialysis patients using a combination of inflammation and calcification markersen_US
dc.typeArticleen_US
dc.identifier.emailWang, M:meiwang@hkucc.hku.hken_US
dc.identifier.authorityWang, M=rp00281en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1093/ndt/gfp325en_US
dc.identifier.pmid19574337-
dc.identifier.scopuseid_2-s2.0-71049116863en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-71049116863&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume24en_US
dc.identifier.issue12en_US
dc.identifier.spage3826en_US
dc.identifier.epage3833en_US
dc.identifier.isiWOS:000272183400046-
dc.publisher.placeUnited Kingdomen_US
dc.identifier.scopusauthoridWang, AYM=13606226000en_US
dc.identifier.scopusauthoridLam, CWK=8531362100en_US
dc.identifier.scopusauthoridChan, IHS=8298775100en_US
dc.identifier.scopusauthoridWang, M=7406690398en_US
dc.identifier.scopusauthoridLui, SF=7102379144en_US
dc.identifier.scopusauthoridSanderson, JE=7202371250en_US

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