Abstract 4077: Reduced Number of CD34+ Circulating Progenitor Cells Is A Strong Predictor of 1-year Cardiovascular Morbidity and Mortality in Chronic Hemodialysis Patients
Background: Endothelial dysfunction plays an important role in progression of cardiovascular disease (CVD). Circulating endothelial progenitor cells (EPCs) are believed to be involved in maintenance of endothelial integrity, and are close proximity to CD34+ circulating progenitor cells (CPCs). On the other hand, patients with chronic kidney disease and hemodialysis (HD) have been regarded as one of the highest risk population for CVD, however, the association of CD34+ CPCs level and CV prognosis has not been clarified in patients with HD. We prospectively examined whether decreased number of CD34+ CPCs would predict CV outcome in patients with HD.
Methods: The number of CD34+ CPCs was determined with the use of flow-cytometry in blood sample before dialysis session in 216 outclinic HD patients. The patients were divided into 2 groups according to a cut-off level of the number of CD34+ CPCs using ROC analysis (AUC=0.70); high CPCs group (<0.37/μl, n=123) and low CPCs group (>0.37/μl, n=93), and were prospectively followed.
Results: Mean age was older in low CPCs group than in high CPCs group (68 years vs 62 years, p<0.0001). Male, duration of HD, diabetes and previous CVD were comparable between the two groups. During 12 months, total 24 unplanned hospitalizations due to CV morbidity and 8 deaths (3 CV deaths) occurred. One-year freedom from CV events and all-cause survival were significantly lower in the low CPCs group than in the high CPCs group (76% versus 92%, p=0.0008 and 92% versus 99%, p=0.0084, respectively). Upon Cox multivariate hazard analysis, low CPCs level (OR 2.99, 95%CI 2.01– 4.46, p=0.0059) and previous CVD (OR 20.40, 95%CI 6.52– 63.94, p=0.0082) were independent predictors for CV events. Furthermore, low CPCs level (OR 7.14, 95%CI 2.44–20.82, p=0.032), age (OR 1.06, 95%CI 1.01–1.13, p=0.033) and BMI (OR 1.44, 95%CI 1.12–1.88, p=0.016) were independent predictors for all-cause mortality.
Conclusion: These data suggest that reduced number of CD34+ CPCs is a strong predictor of cardiovascular morbidity and mortality in chronic HD patients, thus might be a useful biomarker predicting the development of future cardiovascular events even in HD patients.