Plasma Gelsolin and Circulating Actin Correlate with Hemodialysis Mortality

被引:94
作者
Lee, Po-Shun [2 ]
Sampath, Kartik [1 ]
Karumanchi, S. Ananth [3 ,4 ]
Tamez, Hector [1 ]
Bhan, Ishir [1 ]
Isakova, Tamara [1 ]
Gutierrez, Orlando M. [1 ]
Wolf, Myles [1 ]
Chang, Yuchiao [1 ]
Stossel, Thomas P. [2 ]
Thadhani, Ravi [1 ]
机构
[1] Harvard Univ, Sch Med, Massachusetts Gen Hosp, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Brigham & Womens Hosp, Boston, MA 02114 USA
[3] Harvard Univ, Sch Med, Howard Hughes Med Inst, Boston, MA 02114 USA
[4] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Boston, MA 02114 USA
来源
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2009年 / 20卷 / 05期
基金
美国国家卫生研究院;
关键词
ENDOTHELIAL DYSFUNCTION; CARDIOVASCULAR-DISEASE; SCAVENGER SYSTEM; VITAMIN-D; F-ACTIN; SERUM; INFLAMMATION; DIALYSIS; MUSCLE; OUTCOMES;
D O I
10.1681/ASN.2008091008
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
100201 [内科学]; 100221 [泌尿外科学];
摘要
Plasma gelsolin (pGSN) binds actin and bioactive mediators to localize inflammation. Low pGSN correlates with adverse outcomes in acute injury, whereas administration of recombinant pGSN reduces mortality in experimental sepsis. We found that mean pGSN levels of 150 patients randomly selected from 10,044 starting chronic hemodialysis were 140 +/- 42 mg/L, 30 to 50% lower than levels reported for healthy individuals. In a larger sample, we performed a case-control analysis to evaluate the relationship of pGSN and circulating actin with mortality; pGSN levels were significantly lower in 114 patients who died within 1 yr of dialysis initiation than in 109 survivors (117 +/- 38 mg/L versus 147 +/- 42 mg/L, P < 0.001). pGSN levels had a graded, inverse relationship with 1-yr mortality, such that patients with pGSN < 130 mg/L experienced a > 3-fold risk for mortality compared with those with pGSN >= 150 mg/L. The 69% of patients with detectable circulating actin had lower pGSN levels than those without (127 +/- 45 mg/L versus 141 +/- 36 mg/L, P = 0.026). Compared with patients who had elevated pGSN and no detectable actin, those with low pGSN levels and detectable actin had markedly increased mortality (odds ratio 9.8, 95% confidence interval 2.9 to 33.5). Worsening renal function correlated with pGSN decline in 53 subjects with CKD not on dialysis. In summary, low pGSN and detectable circulating actin identify chronic hemodialysis patients at highest risk for 1-yr mortality.
引用
收藏
页码:1140 / 1148
页数:9
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