Increased circulating inflammatory proteins predict a worse prognosis with valvular calcification in end-stage renal disease: A prospective cohort study

Abstract

Background: It remains unknown whether inflammation may predict a worse prognosis with valvular calcification (VC) in end-stage renal disease (ESRD) patients. Method: We prospectively performed echocardiography in 231 ESRD patients receiving chronic peritoneal dialysis treatment to detect VC and then followed them for 3 years or until death. Results: Patients with VC had higher C-reactive protein (CRP; p = 0.001), higher interleukin-6 (IL-6; p = 0.002) and lower fetuin-A (p = 0.004). Stratifying patients into 4 groups on the basis of VC, CRP, IL-6 and fetuin-A, respectively, those with VC and CRP in the upper tertile had 3.68-fold (95% confidence intervals [CI], 1.72-7.88; p = 0.001) and 3.13-fold (95% CI, 1.57-6.24; p = 0.001) respective increases in the adjusted risk of mortality and major adverse cardiovascular event (MACE) than those with no VC and CRP in the lower/middle tertiles. The adjusted hazard ratios (HR) in relation to mortality and MACE were 3.56 (95% CI, 1.53-8.26; p = 0.003) and 2.51 (95% CI, 1.24-5.11; p = 0.011), respectively, for patients with VC and IL-6 in the upper tertile compared to those with no VC and IL-6 in the lower/middle tertiles. The adjusted HR in relation to mortality and MACE were 3.56 (95% CI, 1.53-8.26; p = 0.003) and 2.51 (95% CI, 1.24-5.11; p = 0.011), respectively, for patients with VC and fetuin-A in the lower tertile compared to those with no VC and fetuin-A in the middle/upper tertiles. Conclusions: Increased circulating inflammatory proteins predict a worse prognosis of VC in chronic peritoneal dialysis patients. Copyright © 2008 S. Karger AG.