Original InvestigationDialysisAssociation of Soluble Endotoxin Receptor CD14 and Mortality Among Patients Undergoing Hemodialysis
Section snippets
Patient Population
We studied long-term HD patients who participated in the Nutritional and Inflammatory Evaluation in Dialysis (NIED) Study.12 The original patient cohort was derived from a pool of more than 3,000 HD outpatients during 5 years in 8 DaVita maintenance dialysis facilities in the South Bay Los Angeles, CA, area (see the NIED Study website at www.NIEDStudy.org for more details, as well as previous publications13, 14, 15). Inclusion criteria were outpatients who had been undergoing HD treatment for
Results
The 310 participants in the study were 55.1 ± 14.7 years old and included 48% women, 52% Hispanics, 30% African Americans, and 57% patients with diabetes. Mean dialysis vintage was 50 ± 35 months (median, 45 months; quartile [Q] 1 to Q3, range, 25 to 68). Mean sCD14 level was 7.24 ± 2.45 μg/ml. Table 1 lists relevant demographic, clinical, and laboratory measures across tertiles of sCD14. Age, dialysis vintage, and levels of serum alkaline phosphatase, ferritin, homocysteine, and the 3
Discussion
In this cohort of 310 long-term HD outpatients in Southern California, we found that greater circulating sCD14 level is associated with greater 33-month death risk. The increasing trend of mortality associated with greater sCD14 levels was robust to controlling for case-mix and other nutritional and inflammatory measures, including serum IL-6 and TNF-α levels. Maintenance HD patients in the third tertile of sCD14 levels had an almost-2 fold increased death risk (HR, 1.94) after adjustment for
Acknowledgements
The authors thank Ms Stephanie Griffith and Dr Victor Goh at Harbor-UCLA GCRC Core Laboratories for the management of blood samples and measurement of inflammatory markers; the hard-working collaborating dietitians in 10 DaVita dialysis facilities in Los Angeles South Bay area; and DaVita teammates in these facilities.
Some data were presented during the Spring Clinical Meeting of the National Kidney Foundation in March 25-29, 2009 in Nashville, TN.
Support: This study was supported by National
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Originally published online as doi:10.1053/j.ajkd.2009.06.028 on August 21, 2009.