Abstract 14212: Association of CD34+ Circulating Progenitor Cells and C-Reactive Protein with Cardiovascular and All-cause Mortality in Hemodialysis Patients
Background: Circulating endothelial progenitor cells (EPCs) are believed to be involved in maintenance of endothelial function, and are close proximity to CD34+ circulating progenitor cells (CPCs). C-reactive protein (CRP) also has been reported to reflect vascular wall inflammation and can predict future cardiovascular (CV) events. We investigated the association of CD34+ CPCs, CRP and their joint role in hemodialysis (HD) patients.
Methods: The number of CD34+ CPCs was determined with the use of flow-cytometry in 216 HD patients. To avoid the influence of body fluid overload, the ratio of CD34+ CPCs to peripheral mononuclear cells (CD34+ / PMNCs) were calculated. The patients were divided into tertiles according to CD34+ / PMNCs levels; tertile 1 (T1): <0.012, T2: 0.013–0.022 and T3: >0.023, and also to serum CRP levels; T1: <1.0 mg/l, T2: 1.0–2.8mg/l and T3: >2.8mg/l, respectively. They were followed up for 5 years.
Results: Serum CRP levels were 6.1±9.4mg/l, 3.1±4.1mg/l and 2.1±2.0mg/l in T1, T2 and T3 of CD34+ CPCs levels, respectively (p=0.0010), and were negatively correlated with CD34+ CPCs levels (r=0.31, p<0.0001). Mean follow-up period was 51±13months. Adjusted hazard ratio (HR) of reduced CD34+ CPCs was 3.38 (95%CI 1.24–9.25, p=0.016 for T1 vs. T3) for CV mortality and 2.71 (95%CI 1.20–6.13, p=0.017 for T1 vs. T3) for all-cause mortality. Similarly, among teretiles of CRP, adjusted HR of elevated CRP levels was 4.46 (95%CI 1.46–9.57, p=0.021 for T3 vs. T1) for CV mortality and 3.69 (95%CI 1.56–8.72, p=0.0064 for T3 vs. T1) for all-cause mortality, respectively. In the joint setting of CD34+ CPCs and CRP, the risk of CV and all-cause mortality was 9.8-fold (p=0.020) and 6.9-fold (p=0.013) in the T1 of CD34+ CPCs with T3 of CRP compared with the T3 of CD34+ CPCs with T1 of CRP even after adjustment, respectively .
Conclusions: Reduced number of CD34+ CPCs and elevated CRP levels might be closely associated, and interactively increased mortality risk in HD patients.
- © 2010 by American Heart Association, Inc.