Circulating tumour necrosis factors predict CVD in chronic kidney disease
Circulating tumour necrosis factors (cTNFR) 1 and 2 are independent predictors of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD), a new study reveals.
Over a median follow-up of 3.4±2.0 years, 3.7 percent (n=36) of CKD patients (n=984; mean age 49.7±15.8 years; 56.1 percent male) developed CVD. Significantly more patients in the highest tertile of cTNFR1 and cTNFR2 levels had CVD compared to the lowest tertile (p<0.001).
Multivariate regression analysis showed that cTFNR1 and cTNFR2 levels were significant independent predictors of CVD (hazard ratio [HR], 2.506; 95 percent CI, 1.186 to 5.295; p=0.016; and HR, 4.156; 1.913 to 9.030; p<0.001, respectively) and end-stage renal disease (ESRD; HR, 5.927; 3.412 to 10.296; p<0.001; and HR, 3.297; 2.192 to 4.959; p<0.001, respectively).
On the other hand, only cTNFR2 levels were associated with all-cause mortality (HR, 7.448; 2.319 to 23.925; p=0.001). Models were fully-adjusted for sex, age, inflammation and other CVD factors.
A total of 19 deaths (1.9 percent) and 174 ESRD cases (17.7 percent) were recorded over the follow-up period.
The most common comorbidity among the participants was hypertension (53.6 percent; n=527) followed by diabetes (27.1 percent; n=267). The mean estimated glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hs-CRP) level were 50.8±31.6 mL/min/1.73 m2 and 0.7±2.4 mg/dL, respectively.
Eligible study participants were divided into tertiles according to measured cTNFR1 and cTNFR2 levels. The primary endpoint of the study was occurrence of nonfatal myocardial infarction, stroke, revascularization or cardiovascular death. Patients with histories of heart failure or organ transplants were excluded.