Nutritional Status, Uremic Toxins, and Metabo-Inflammatory Biomarkers as Predictors of Two-Year Cardiovascular Mortality in Dialysis Patients: A Prospective Study.

Patients with chronic kidney disease (CKD) are at a significantly increased risk of cardiovascular (CV) mortality, which cannot be fully accounted for by traditional risk factors. Background/Objectives: The aim of this study is to evaluate the impact of adipokines, myokines, gut-microbiota-derived uremic toxins, and nutritional status on the risk of CV mortality in patients undergoing kidney replacement therapy (KRT). Methods: This study includes 84 hemodialysis (HD) patients and 44 peritoneal dialysis (PD) patients. Adipokines and myokines concentrations were measured using enzyme-linked immunosorbent assays (ELISA), while gut-microbiota-derived uremic toxins were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Nutritional status was assessed using the seven-point Subjective Global Assessment (SGA) and anthropometric measurements. The survival was analyzed using Kaplan-Meier curves with the log-rank test, along with univariate and multivariate Cox proportional hazards regression. Results: The mean follow-up period was 18.2 (8) months for the HD group and 14.3 (8) months for the PD group. During the 2-year follow-up, 15.5% of HD patients and 6.8% of PD patients died due to cardiovascular disease (CVD). In the HD group, age, blood urea nitrogen (BUN), phosphorus, interleukin-6 (IL-6), high-sensitivity C-protein (hsCRP), and neutrophil-to-lymphocyte ratio (NLR) levels were significantly associated with CV mortality. HD patients who died had significantly lower myostatin/IL-6 ratios. CV mortality was significantly associated with age and potassium levels in the PD group. Conclusions: The examined adipokines, myokines, and gut-microbiota-derived uremic toxins exert a less significant direct influence on survival compared to widely recognized indicators, including age, nutritional status, and inflammatory markers.