TNFR 1, 2 linked to all-cause, cardiovascular mortality in haemodialysis
The risk of all-cause and cardiovascular mortality among end-stage renal disease patients receiving haemodialysis may be associated with increased levels of the circulating tumour necrosis factor receptors (TNFR), a new study reports.
The study included 319 patients undergoing haemodialysis. Only those who were clinically stable and with baseline serum data were included; those who had advanced dementia, were hospitalized two months prior or received haemodialysis for <1 month were excluded.
The primary outcomes were cardiovascular and all-cause mortality. These included mortalities from myocardial infarction, arrhythmia, stroke and congestive heart failure. Enzyme-linked immunosorbent assay was used to measure TNFR 1, 2 and total TNF-α levels.
Of the participants, 60.8 percent were male and 50.2 percent had diabetes. After a median follow-up period of 53 months, 72.4 percent of the participants remained alive. Of those who died, 45.5 percent died because of cardiovascular diseases.
Univariate analysis showed that all-cause mortality was significantly associated with both TNFRs (TNFR1: hazard ratio [HR], 2.42; 95 percent CI, 1.58 to 3.70; p<0.0001; TNFR2: HR, 2.70; 1.77 to 4.13; p<0.0001) but not with TNF-α. This trend remained significant even after controlling for other variables like age, blood pressure and prior cardiovascular diseases (TNFR1: HR, 2.34; 1.50 to 3.64; p<0.0001; TNFR2: HR, 2.13; 1.38 to 3.29; p<0.0001).
Only TNFR1 showed significant association with cardiovascular mortality after controlling for variables (HR, 2.15; 1.13 to 4.10; p=0.02).
The findings thus show a correlation between all-cause and cardiovascular mortality and circulating TNFRs in end-stage renal disease patients undergoing haemodialysis.