Plasma oxalic acid and cardiovascular risk in end-stage renal disease patients: a prospective, observational cohort pilot study
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Background/Aims: It was hypothesized that oxalate might be strongly involved in atherogenesis and the inflammatory pathway that could result in an increased risk of cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients. Therefore, this study aimed to address two primary research questions: to characterize the lipid profile and the pattern of pro-inflammatory cytokines according to plasma oxalic acid (POx) concentration in ESRD patients; to evaluate the potential role of elevated POx concentration in the development of CVD risk. Methods: A total of 73 participants were enrolled in this prospective, observational cohort pilot study. Among them, there were 50 ESRD patients and 23 healthy volunteers. The lipid profile and the pro-inflammatory cytokines were analyzed according to the distribution of POx concentration into tertiles. After the clinical examination, 29 hemodialysis patients and 21 peritoneal dialysis patients without prevalent CVD were observed for CVD events for 2 years. The Cox regression analysis and a set of different types of sensitivity analyses were used to determine whether elevated POx was associated with an increased risk of CVD. Results: An increasing trend in the atherogenic lipoprotein fractions and the pro-inflammatory markers as well as a linear decrease in high-density lipoprotein was significantly associated with elevated POx. POx concentration ≥ 62.9 μmol/L was significantly associated with CVD events independently of other examined CVD risk factors. Conclusions: This pilot study firstly demonstrated a potential contribution of POx to atherogenesis, inflammation and CVD risk in ESRD patients.
Abstract
Background/Aims: It was hypothesized that oxalate might be strongly involved in atherogenesis and the inflammatory pathway that could result in an increased risk of cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients. Therefore, this study aimed to address two primary research questions: to characterize the lipid profile and the pattern of pro-inflammatory cytokines according to plasma oxalic acid (POx) concentration in ESRD patients; to evaluate the potential role of elevated POx concentration in the development of CVD risk. Methods: A total of 73 participants were enrolled in this prospective, observational cohort pilot study. Among them, there were 50 ESRD patients and 23 healthy volunteers. The lipid profile and the pro-inflammatory cytokines were analyzed according to the distribution of POx concentration into tertiles. After the clinical examination, 29 hemodialysis patients and 21 peritoneal dialysis patients without prevalent CVD were observed for CVD events for 2 years. The Cox regression analysis and a set of different types of sensitivity analyses were used to determine whether elevated POx was associated with an increased risk of CVD. Results: An increasing trend in the atherogenic lipoprotein fractions and the pro-inflammatory markers as well as a linear decrease in high-density lipoprotein was significantly associated with elevated POx. POx concentration ≥ 62.9 μmol/L was significantly associated with CVD events independently of other examined CVD risk factors. Conclusions: This pilot study firstly demonstrated a potential contribution of POx to atherogenesis, inflammation and CVD risk in ESRD patients.
참고문헌 (39)
- Cozzolino M, "Cardiovascular disease in dialysis patients", Nephrol Dial Transplant, 33(suppl 3), pp.iii28~iii34 (2018)
- Stenvinkel P, "Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient : how do new pieces fit into the uremic puzzle?", Clin J Am Soc Nephrol, 3, pp.505~521 (2008)
- Demikhov O, "Arterial hypertension prevention as an actual medical and social problem", Bangladesh J Med Sci, 19, pp.722~729 (2020)
- Shifris IM, "Diabetic status, comorbidity and survival in patients with chronic kidney disease stage VD : a cohort study", Probl Endocr Pathol, 2, pp.95~103 (2020)
- Kon V, "Residual cardiovascular risk in chronic kidney disease : role of high-density lipoprotein", Arch Med Res, 46, pp.379~391 (2015)
- Devarajan A, "Cross-talk between renal lithogenesis and atherosclerosis:an unveiled link between kidney stone formation and cardiovascular diseases", Clin Sci(Lond), 132, pp.615~626 (2018)
- Dominguez-Gutierrez PR, "Calcium oxalate differentiates human monocytes into inflammatory M1 macrophages", Front Immunol, 9, pp.1863~ (2018)
- Ermer T, "Oxalate, inflammasome, and progression of kidney disease", Curr Opin Nephrol Hypertens, 25, pp.363~371 (2016)
- Stepanova N, "Hyperoxaluria-associated cytokines dysregulation in women with recurrent pyelonephritis", Int Med J, 25, pp.783~790 (2020)
- Aydin H, "Increased 10-year cardiovascular disease and mortality risk scores in asymptomatic patients with calcium oxalate urolithiasis", Urol Res, 39, pp.451~458 (2011)
- Arafa A, "Oxalates, urinary stones and risk of cardiovascular diseases", Med Hypotheses, 137, pp.109570~ (2020)
- Perinpam M, "Plasma oxalate in relation to eGFR in patients with primary hyperoxaluria, enteric hyperoxaluria and urinary stone disease", Clin Biochem, 50, pp.1014~1019 (2017)
- Prenen JA, "Plasma oxalate concentration and oxalate distribution volume in patients with normal and decreased renal function", Eur J Clin Invest, 15, pp.45~49 (1985)
- Mydlik M, "Oxalic acid as a uremic toxin", J Ren Nutr, 18, pp.33~39 (2008)
- Levin RI, "Oxalate, a potential atherogenic toxin of uremia, inhibits endothelial proliferation induced by heparin-binding growth factors in vitro", Endothelium, 1, pp.179~192 (1993)
- Recht PA, "Oxalic acid alters intracellular calcium in endothelial cells", Atherosclerosis, 173, pp.321~328 (2004)
- Marangella M, "Plasma profiles and dialysis kinetics of oxalate in patients receiving hemodialysis", Nephron, 60, pp.74~80 (1992)
- Sim J, "The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency", J Clin Epidemiol, 65, pp.301~308 (2012)
- Kidney disease : improving global outcomes(KDIGO)lipid work group, "KDIGO clinical practice guideline for lipid management in chronic kidney disease", Kidney Int Suppl, 3, pp.259~305 (2013)
- Ferraro PM, "History of kidney stones and the risk of coronary heart disease", JAMA, 310, pp.408~415 (2013)
- Lin SY, "Association between kidney stones and risk of stroke: a nationwide population-based cohort study", Medicine(Baltimore), 95, pp.e2847~ (2016)
- Jeong IG, "Association between metabolic syndrome and the presence of kidney stones in a screened population", Am J Kidney Dis, 58, pp.383~388 (2011)
- Vale L, "Metabolic evaluation in urolithiasis : study of the prevalence of metabolic abnormalities in a tertiary centre", Cent European J Urol, 73, pp.55~61 (2020)
- Masterson JH, "Dyslipidemia is associated with an increased risk of nephrolithiasis", Urolithiasis, 43, pp.49~53 (2015)
- Di Lullo L, "Chronic kidney disease and cardiovascular complications", Heart Fail Rev, 20, pp.259~272 (2015)
- Yamamoto S, "Mechanisms for increased cardiovascular disease in chronic kidney dysfunction", Curr Opin Nephrol Hypertens, 18, pp.181~188 (2009)
- Torricelli FC, "Dyslipidemia and kidney stone risk", J Urol, 191, pp.667~672 (2014)
- Gulhan B, "The relationship between serum oxalic acid, central hemodynamic parameters and colonization by oxalobacter formigenes in hemodialysis patients", Cardiorenal Med, 5, pp.164~174 (2015)
- Yang X, "Oxidative stress-mediated atherosclerosis : mechanisms and therapies", Front Physiol, 8, pp.600~ (2017)
- Navab M, "The role of dysfunctional HDL in atherosclerosis", J Lipid Res, 50(Suppl), pp.S145~S149 (2009)
- Ilhan F, "Atherosclerosis and the role of immune cells", World J Clin Cases, 3, pp.345~352 (2015)
- Stepanova N, "Inverse association between dialysate oxalate removal and intraperitoneal inflammation in peritoneal dialysis patients", Nephrol Dial Transplant, 35(Suppl 3), pp.1215~ (2020)
- Stepanova N, "Dyslipidemia and intraperitoneal inflammation axis in peritoneal dialysis patients:a cross-sectional pilot study", Kidney Dis(Basel), 6, pp.35~42 (2020)
- Khan SR, "Reactive oxygen species, inflammation and calcium oxalate nephrolithiasis", Transl Androl Urol, 3, pp.256~276 (2014)
- Horuz R, "Role of TNF-associated cytokines in renal tubular cell apoptosis induced by hyperoxaluria", Urolithiasis, 41, pp.197~203 (2013)
- Dhondup T, "Risk of ESRD and mortality in kidney and bladder stone formers", Am J Kidney Dis, 72, pp.790~797 (2018)
- Shah RJ, "Plasma oxalate as a predictor of kidney function decline in a primary hyperoxaluria cohort", Int J Mol Sci, 21, pp.3608~ (2020)
- Mulay SR, "Oxalate-induced chronic kidney disease with its uremic and cardiovascular complications in C57BL", 6 mice, 2016, pp.310, F785~F795
- Tomson CR, "Plasma oxalate concentration, oxalate clearance and cardiac function in patients receiving haemodialysis", Nephrol Dial Transplant, 4, pp.792~799 (1989)