Povezanost eozinofilnoga kationskoga proteina s uznapredovalošću ateroskleroze karotidne arterije i sveukupnim preživljenjem bolesnika na programu kronične hemodijalize [Correlation of eosinophil cationic protein with severity of carotid atherosclerosis and all-cause mortality in patients on hemodialysis]

Abstract

The prevalence of cardiovascular diseases in patients with renal insufficiency treated with chronic dialysis is high. It is considered that increased prevalence of cardiovascular diseases in this population is a result of accelerated atherosclerosis which is associated with “new” risk factors such as highly sensitive protein C (hs CRP), proband brain natriuretic peptide (NT-pro-BNP), homocysteine, lipoproteine (a), inflammation and oxidative stress. Eosinophile cationic protein (ECP) is zinc cationic protein which is stored in human organism in the eosinophiles’ granolas. According to the recent studies serum concentration of ECP in proportional to severity of coronary atherosclerosis, and it is considered as biomarker of coronary atherosclerosis. The aim of this study is to investigate the correlation between ECP and surrogates of atherosclerosis and to investigate whether there is prognostic significance of biomarkers such as ECP, hsCRP, red cell distribution width (RDW) in regard to overall survival of patients on chronic hemodialysis. Results of our research show that patients on chronic dialysis have advanced atherosclerotic changes on carotid arteries (intima media thickness – IMT 0,68±0,19; overall severity of plaque burden – PS 14,75±14,85) and significantly higher serum concentrations of ECP (ECP 17,01±14,12) in regard to general population (IMT 0,50±0,12, PS 6,57±3,75, ECP 10,78±9,38) (P<0,0001; p<0,0001; P=0,0012, respectively). According to our results there is no statistically significant correlation between ECP and IMT (rho 0,168, P=0,0938). Between ECP and overall severity of plaque burden of carotid arteries there is statistically significant, but marginal correlation (r=0,234, P=0,0193). We have validated prognostic significance of previously known important biomarkers such as hsCRP. In univariate Cox proportional analysis ECP is identified as statistically significant prognostic marker (HR 1,0322, P=0,049), but after correction for known risk factors for atherosclerosis, it became insignificant. We have identified RDW as strong independent and additive prognostic biomarker of overall survival of patients on chronic dialysis (HR 1,5346; P=0,0028) which remained significant even after correction for known atherosclerotic risk factors. In the population of patients treated with chronic dialysis ECP does not represents significant biomarker of carotid atherosclerosis, and as such it does not have clinical applicable value. RDW seems as an independent and additive prognostic biomarker for overall survival of patients on chronic dialysis