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.