Skip to Main content Skip to Navigation
Journal articles

Serum markers of fibrosis, cardiovascular and all-cause mortality in hemodialysis patients: the AURORA trial

Madonna Salib 1, 2, 3, 4 Sophie Girerd 1, 2, 3, 4, 5 Nicolas Girerd 1, 2, 3, 4, 5 Winfried März 6, 7 Hubert Scharnagl 7 Ziad Massy 3, 4, 8, 9, 10 Céline Leroy 1, 2, 3, 4 Kévin Duarte 1, 2, 3, 4 Hallvard Holdaas 11 Alan Jardine 12, 13, 14 Roland Schmieder 15 Bengt Fellström 16 Natalia López-Andrés 17, 18, 19 Patrick Rossignol 1, 2, 3, 4 Faiez Zannad 1, 2, 3, 4
Abstract : Background: Biomarkers of fibrosis are associated with outcome in several cardiovascular diseases. However, their relevance to chronic kidney disease and dialysis is uncertain, as it remains unclear how the kidneys and the dialysis procedure itself affect their elimination and degradation. We aimed to investigate the relationship of the blood levels of two markers associated with fibrosis: procollagen type I C-terminal pro-peptide (PICP) and galectin-3 (Gal-3) with mortality in dialysis patients. Methods: Procollagen type I C-terminal pro-peptide and galectin-3 were measured at baseline in 2773 patients enrolled in the AURORA trial, investigating the effect of rosuvastatin on cardiovascular outcomes, in patients on hemodialysis, and their interaction with CV death or all-cause mortality using survival models. The added prognostic value of these biomarkers was assessed by the net reclassification improvement (NRI). Results: The median follow-up period was 3.8 years. Blood concentrations of PICP and Gal-3 were significantly associated with CV death [adjusted HR per 1 SD = 1.11 (1.02-1.20) and SD = 1.20 (1.10-1.31), respectively] and all-cause mortality (all adjusted p < 0.001). PICP and Gal-3 had a synergistic effect with regard to CV death and all-cause mortality (interaction p = 0.04 and 0.01, respectively). Adding PICP, Gal-3 and their interaction on top of clinical and biological covariates, resulted in significantly improved prognostic accuracy NRI = 0.080 (0.019-0.143) for CV death. Conclusion: In dialysis patients, concomitant increase in PICP and Gal-3 concentrations are associated with higher rates of CV death. These results suggest that concomitantly raised PICP and Gal-3 may reflect an activated fibrogenesis relevant to risk stratification in dialysis, raising the hypothesis that anti-fibrotic therapy may be beneficial for cardiovascular protection in such patients.
Complete list of metadata

https://hal.univ-lorraine.fr/hal-03272812
Contributor : Erwan Bozec <>
Submitted on : Monday, June 28, 2021 - 4:05:32 PM
Last modification on : Sunday, August 22, 2021 - 3:22:49 AM

Files

 Restricted access
To satisfy the distribution rights of the publisher, the document is embargoed until : 2021-12-25

Please log in to resquest access to the document

Identifiers

Citation

Madonna Salib, Sophie Girerd, Nicolas Girerd, Winfried März, Hubert Scharnagl, et al.. Serum markers of fibrosis, cardiovascular and all-cause mortality in hemodialysis patients: the AURORA trial. Clinical Research in Cardiology, Springer Verlag, 2021, ⟨10.1007/s00392-021-01898-9⟩. ⟨hal-03272812⟩

Share

Metrics

Record views

68