Oxidative Stress and Inflammation as Predictors of Mortality and Cardiovascular Events in Hemodialysis Patients: The DREAM Cohort.

Abstract

AIM:

Both oxidative stress and inflammation are involved in the pathogenesis of cardiovascular disease (CVD). The serum level of derivatives of reactive oxygen metabolites (d-ROMs) is a measure of the total amount of hydroperoxides serving as a marker of oxidative stress. We investigated whether d-ROMs could predict the clinical outcomes in hemodialysis patients and whether the associations of d-ROMs with the outcomes are independent of a marker of inflammation, C-reactive protein (CRP).

METHODS:

This was a prospective cohort study in hemodialysis patients. The key exposures were the serum levels of d-ROMs and CRP. The outcome measures were all-cause mortality and new CVD events.

RESULTS:

A total of 517 patients were analyzed. d-ROMs correlated positively with CRP. During follow-up for 5 years, 107 patients died, and 190 patients experienced new CVD events. In the Kaplan-Meier analyses, both higher d-ROMs and higher CRP levels predicted higher risks for mortality and CVD events. By Cox proportional-hazard regression analysis adjusted for potential confounders excluding CRP, d-ROMs exhibited a significant association with all-cause mortality, but this association was no longer significant after further adjustment for CRP. Using the same model, CRP exhibited a significant association with all-cause mortality, but this association was no longer significant after further adjustment for d-ROMs. When we analyzed new CVD events as the outcome, CRP was a significant predictor, whereas the level of d-ROMs was not.

CONCLUSIONS:

Although d-ROMs predicted mortality and CVD events in unadjusted models, the associations of d-ROMs with these outcomes were not independent of CRP. Oxidative stress and inflammation appear to share common causal pathways.

• Authors: Keyaki Sasaki, Tetsuo Shoji, Daijiro Kabata, Ayumi Shintani, Yujiro Okute, Shoko Tsuchikura, Naoko Shimomura, Yoshihiro Tsujimoto, Shinya Nakatani, Katsuhito Mori, Atsushi Shioi, Masaaki Inaba, Masanori Emoto
• Journal: Journal of atherosclerosis and thrombosis (J Atheroscler Thromb) Vol. 28 Issue 3 Pg. 249-260 (Mar 01 2021) ISSN: 1880-3873 [Electronic] Japan
• PMID: 32741893 (Publication Type: Journal Article, Observational Study)

Chemical References

• Reactive Oxygen Species
• C-Reactive Protein

Topics

• Aged
• C-Reactive Protein (metabolism)
• Cardiovascular Diseases (epidemiology)
• Cohort Studies
• Cross-Sectional Studies
• Female
• Humans
• Inflammation
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Oxidative Stress (physiology)
• Predictive Value of Tests
• Proportional Hazards Models
• Reactive Oxygen Species (blood)
• Renal Dialysis
• Renal Insufficiency, Chronic (blood, mortality, therapy)
• Risk Factors
• Survival Rate