High Plasma Angiopoietin-2 Levels Predict the Need to Initiate Dialysis within Two Years in Patients with Chronic Kidney Disease
Abstract
:1. Introduction
2. Results
2.1. Correlations in the Entire Cohort
2.2. Univariate and Multivariate Regression
2.3. Ang-2, VCAM, and B-Trace Protein in Progressors vs. Nonprogressors
2.4. Impact of Angiopoetin-2 on Renal Survival (RRT Initiation)
3. Discussion
4. Materials and Methods
4.1. Participants
4.2. Study Design
4.2.1. Lung Ultrasonography (B-Lines)
4.2.2. Echocardiography with GLS
4.2.3. Bioimpedance
4.2.4. Six-Minute Walk Test
4.2.5. Quantification of Circulating Biomarkers
4.3. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | Mean | Median | 25–75% [IQR] |
---|---|---|---|
Age (years) | 52.6 | 52.0 | 42–66 |
Body mass index (kg/m2) | 25.9 | 25.7 | 22.2–27.9 |
6-MWT (m) | 407.6 | 420.0 | 360–480 |
Sys BP (mmHg) | 144.3 | 144.0 | 127–160 |
Dia BP (mmHg) | 87.4 | 85.0 | 80–100 |
Heart rate (1/min) | 71.6 | 70.0 | 62–81 |
Biochemistry | |||
Serum creatinine (mg/dL) | 4.3 | 3.8 | 2.3–5.8 |
eGFR (mL/min/1.73 m2) | 21.9 | 16.0 | 10–28 |
Urea (mg/dL) | 105.2 | 97.0 | 64–142 |
BNP (ng/mL) | 376.7 | 103.3 | 37.6–287.8 |
cTnI (ng/dL) | 17.4 | 8.9 | 4.3–18.8 |
Hemoglobin (mmol/L) | 11.2 | 11.0 | 9.6–12.4 |
Sodium (mmol/L) | 140.3 | 140.0 | 139–142 |
Urine osmolality (mOsm/kg H2O) | 338.3 | 335.5 | 259–402 |
Serum osmolality (mOsm/kg H2O) | 303.2 | 303.5 | 295–313 |
Uric acid (mg/dL) | 7.3 | 7.3 | 6.3–8.3 |
Serum albumin (g/dL) | 3.6 | 3.6 | 3.2–4.1 |
Total protein (g/dL) | 6.2 | 6.2 | 5.5–6.9 |
C-reactive protein (mg/L) | 7.7 | 2.4 | 1.1–6 |
Procalcitonin (ng/mL) | 0.1 | 0.1 | 0.0–0.1 |
Ultrasound examination | |||
B-lines (Lung US) | 10.8 | 7.0 | 3–13 |
LVEF (%) | 61.4 | 65.0 | 60–65 |
GLS | −17.6 | −18.0 | −19.8–−14.9 |
Mitral E/e′ | 8.9 | 8.3 | 6.7–10.2 |
LVM index | 130.7 | 123.0 | 99–156 |
Bioimpedance | |||
ECW (L) | 22.5 | 21.7 | 17.1–26.1 |
ICW (L) | 23.8 | 23.2 | 18–27.4 |
ECW/ICW | 1.0 | 0.9 | 0.8–1.1 |
Biomarkers of congestion or endothelial injury/activation | |||
VCAM-1 (ng/mL) | 1476.1 | 1358.0 | 1081.5–1759.0 |
ANGIOPOETIN-2 (ng/mL) | 4.3 | 3.1 | 2.3–5.0 |
VEGF-C (ng/mL) | 4.9 | 4.7 | 3.7–5.8 |
Copeptin (pg/mL) | 893.8 | 574.0 | 342.5–1432.5 |
B-trace-protein (ng/mL) | 1537.4 | 1497.0 | 1095–1993 |
BMI | ECW/ ICW | 6 MWT | B-Lines | e/e′ | EF | GLS | VCAM-1 | Ang-2 | VEGF-C | CPP | B-TP | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | 0.14 | 0.35 * | −0.47 | 0.13 | 0.28 | 0.02 | 0.10 | −0.10 | −0.06 | −0.19 | −0.33 | −0.12 |
BNP | −0.11 | 0.46 | −0.38 | 0.40 | 0.42 | −0.10 | 0.28 | 0.50 | 0.58 | −0.12 | 0.00 | 0.46 |
cTnI | −0.16 | 0.31 | −0.35 | 0.32 | 0.45 | −0.13 | 0.41 | 0.44 | 0.42 | −0.02 | −0.13 | 0.15 |
Hemoglobin | 0.19 | −0.48 | 0.33 | −0.33 | −0.01 | 0.01 | −0.01 | −0.21 | −0.48 | 0.20 | −0.01 | −0.39 |
Na | −0.12 | 0.28 | −0.11 | 0.05 | −0.09 | 0.02 | −0.18 | 0.18 | 0.17 | −0.11 | −0.07 | −0.01 |
U osmolality | 0.18 | 0.06 | 0.20 | −0.02 | −0.03 | 0.21 | 0.06 | −0.40 | −0.30 | −0.03 | −0.12 | −0.45 |
S osmolality | 0.08 | 0.06 | −0.11 | 0.11 | −0.11 | 0.06 | −0.11 | 0.09 | 0.23 | −0.02 | −0.02 | 0.22 |
Uric acid | 0.26 | 0.01 | 0.10 | −0.10 | −0.28 | 0.13 | −0.35 | −0.17 | −0.18 | −0.21 | −0.03 | −0.42 |
S creatinine | −0.10 | 0.08 | −0.09 | 0.26 | −0.04 | −0.11 | 0.03 | 0.48 | 0.57 | 0.03 | −0.01 | 0.74 |
eGFR | 0.20 | −0.20 | 0.19 | −0.29 | −0.02 | 0.11 | −0.04 | −0.49 | −0.61 | 0.12 | −0.12 | −0.75 |
urea | −0.13 | 0.23 | −0.18 | 0.26 | −0.09 | −0.02 | −0.05 | 0.25 | 0.30 | −0.09 | 0.10 | 0.23 |
S albumin | 0.13 | −0.35 | 0.15 | −0.08 | −0.12 | −0.15 | −0.03 | −0.09 | 0.02 | −0.20 | −0.12 | 0.19 |
CRP | −0.12 | 0.26 | −0.31 | 0.24 | 0.17 | −0.01 | 0.01 | 0.24 | 0.34 | −0.14 | −0.15 | 0.19 |
procalcitonin | −0.11 | 0.24 | −0.37 | 0.37 | 0.36 | −0.16 | 0.14 | 0.58 | 0.56 | 0.08 | −0.18 | 0.61 |
Univariate Regression | ||||
---|---|---|---|---|
Risk Factor | HR | 2.5% | 97.5% | p-Value |
VCAM-1 | 1.0010 | 1.0000 | 1.0010 | 0.0017 |
Ang-2 | 1.1770 | 1.0380 | 1.3350 | 0.0113 |
B-trace-protein | 1.0010 | 1.0010 | 1.0020 | 0.0001 |
VEGF-C | 1.0000 | 0.9968 | 1.0001 | 0.4520 |
eGFR | 0.8867 | 0.8477 | 0.9276 | 0.0000 |
BNP | 1.0000 | 0.9998 | 1.0010 | 0.2520 |
Copeptin | 0.9998 | 0.9994 | 1.0000 | 0.5280 |
Regression | Univariate | Multivariate | |||||||
---|---|---|---|---|---|---|---|---|---|
Model | Risk Factor | HR | 2.5% | 97.5% | p-Value | HR | 2.5% | 97.5% | p-Value |
1 | VCAM-1 | 1.0010 | 1.0000 | 1.0010 | 0.0017 | 1.0007 | 1.0001 | 1.0010 | 0.0144 |
Ang-2 | 1.1770 | 1.0380 | 1.3350 | 0.0113 | 1.1179 | 0.9801 | 1.2750 | 0.0968 | |
Copeptin | 0.9998 | 0.9994 | 1.0000 | 0.5280 | 0.9999 | 0.9994 | 1.0000 | 0.7679 | |
2 | Ang-2 | 1.1770 | 1.0380 | 1.3350 | 0.0113 | 1.1790 | 1.0157 | 1.3690 | 0.0304 |
BNP | 1.0000 | 0.9998 | 1.0010 | 0.2520 | 1.0000 | 0.9994 | 1.0010 | 0.9582 |
Parameter | Group I, n = 31 (Nonprogressors) | Group II, n = 47 (Progressors) | Dialysis Group (CKD5-HD), n = 22 | p < 0.05 | |||
---|---|---|---|---|---|---|---|
Median | 25–75% [IQR] | Median | 25–75% [IQR] | Median | 25–75% [IQR] | ||
Age (years) | 51.0 | 42–64 | 59.0 | 44–68 | 52.5 | 38.5–65.5 | Ns |
Body mass index (kg/m2) | 24.6 | 22.3–27 | 25.7 | 22.3–28 | 25.4 | 21.5–30 | Ns |
6-MWT (m) | 440.0 | 395–500 | 400.0 | 360–475 | 390.0 | 320–460 | I vs. II, I vs. HD |
Sys BP (mmHg) | 144.0 | 125–150 | 140.0 | 127–150 | 149.5 | 127.5–170 | Ns |
Dia BP (mmHg) | 85.0 | 80–94 | 83.0 | 80–93 | 97.0 | 80–100 | I vs. HD, II vs. HD |
Heart rate (1/min) | 71.5 | 63–75 | 70.0 | 62–80 | 69.0 | 58–90 | Ns |
Serum creatinine (mg/dL) | 2.3 | 1.5–3.2 | 3.8 | 2.4–5.2 | 6.7 | 5.4–7.6 | I vs. II, I vs. HD, II vs. HD |
eGFR (mL/min/1.73 m2) | 28.0 | 22–46 | 17.0 | 11–27 | 9.0 | 7.5–11 | I vs. II, I vs. HD, II vs. HD |
24 M eGFR (mL/min/1.73 m2) | 31.0 | 23–50 | 6.0 | 5–13 | 6.0 | 30–54 | I vs. II, I vs. HD |
Urea (mg/dL) | 76.0 | 58–93 | 112.0 | 66–142 | 131.0 | 70–158 | I vs. II, I vs. HD |
BNP (ng/mL) | 56.6 | 23.2–208 | 105.2 | 48–188.6 | 274.5 | 54.8–856 | I vs. II, I vs. HD, II vs. HD |
cTnI (ng/dL) | 8.3 | 3.6–16.8 | 8.2 | 4.1–13.7 | 15.9 | 4.4–30 | Ns |
Hemoglobin (mmol/L) | 11.7 | 10.3–13 | 11.0 | 9.6–12.4 | 10.1 | 9.2–11.9 | I vs. HD |
Sodium (mmol/L) | 140.0 | 138–143 | 140.0 | 139–142 | 140.0 | 139–141 | Ns |
Urine osmolality (mOsm/kg H2O) | 402.0 | 339–450 | 319.0 | 248–399 | 293.0 | 239–326 | I vs. II, I vs. HD, II vs. HD |
Serum osmolality (mOsm/kg H2O) | 297.0 | 291–306 | 304.5 | 299–317 | 309.0 | 296–313 | I vs. II, I vs. HD, II vs. HD |
Uric acid (mg/dL) | 7.5 | 6.6–8.3 | 7.4 | 6.4–8.4 | 6.7 | 4.2–8.1 | Ns |
Serum albumin (g/dL) | 3.5 | 2.8–4 | 3.5 | 3.2–4 | 3.9 | 3.3–4.2 | Ns |
C-reactive protein (mg/L) | 2.1 | 1.1–6.4 | 1.8 | 0.8–5 | 5.0 | 2–9.2 | Ns |
Procalcitonin (ng/mL) | 0.05 | 0.0–0.1 | 0.07 | 0.0–0.1 | 0.18 | 0.1–0.3 | I vs. HD, II vs. HD |
B-lines (LUS) | 5.0 | 3–12 | 7.0 | 4–13 | 8.0 | 5.5–22 | I vs. II, I vs. HD, II vs. HD |
ECW (L) | 21.1 | 17.9–24.4 | 23.3 | 17.7–26.4 | 20.7 | 15.9–28 | Ns |
ICW (L) | 24.9 | 18–28.3 | 23.8 | 20–27.1 | 22.7 | 18–26.4 | Ns |
ECW/ICW | 0.9 | 0.8–1 | 1.0 | 0.8–1.1 | 0.9 | 0.9–1.1 | Ns |
Ejection fraction (%) | 65.0 | 60–65 | 65.0 | 60–65 | 60.0 | 55–65 | Ns |
GLS | −18.9 | −20–−16.7 | −18.2 | −21.5–−15 | −15.9 | −19.1–−13.4 | Ns |
Mitral E/e′ | 7.0 | 6.2 | 8.2 | 6.4–10 | 10.0 | 7.4–11 | Ns |
LVM index | 110.0 | 100–134 | 125.0 | 94–153 | 139.0 | 103–187 | I vs. HD |
VCAM-1 (ng/mL) | 1134.5 | 1005–1415 | 1300.0 | 1076–1636 | 1685.0 | 1386.5–2240 | I vs. II, I vs. HD, II vs. HD |
Ang-2 (ng/mL) | 2.4 | 1.9–3.5 | 2.9 | 2.2–4.2 | 5.1 | 4.2–8.1 | I vs. II, I vs. HD, II vs. HD |
VEGF-C (ng/mL) | 4.7 | 3.7–6 | 5.0 | 4.3–5.9 | 4.6 | 3.0–5.6 | Ns |
Copeptin (pg/mL) | 490.0 | 271–739 | 572.0 | 357–960 | 362.5 | 322–576 | II vs. HD |
B-trace protein (ng/mL) | 963.0 | 562.5–1364 | 1406.0 | 1014–1711 | 2088.0 | 1683–2374 | I vs. II, I vs. HD, II vs. HD |
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Szymczak, A.; Kusztal, M.; Gołębiowski, T.; Letachowicz, K.; Goździk, A.; Kościelska-Kasprzak, K.; Tukiendorf, A.; Krajewska, M. High Plasma Angiopoietin-2 Levels Predict the Need to Initiate Dialysis within Two Years in Patients with Chronic Kidney Disease. Int. J. Mol. Sci. 2023, 24, 10036. https://doi.org/10.3390/ijms241210036
Szymczak A, Kusztal M, Gołębiowski T, Letachowicz K, Goździk A, Kościelska-Kasprzak K, Tukiendorf A, Krajewska M. High Plasma Angiopoietin-2 Levels Predict the Need to Initiate Dialysis within Two Years in Patients with Chronic Kidney Disease. International Journal of Molecular Sciences. 2023; 24(12):10036. https://doi.org/10.3390/ijms241210036
Chicago/Turabian StyleSzymczak, Anna, Mariusz Kusztal, Tomasz Gołębiowski, Krzysztof Letachowicz, Anna Goździk, Katarzyna Kościelska-Kasprzak, Andrzej Tukiendorf, and Magdalena Krajewska. 2023. "High Plasma Angiopoietin-2 Levels Predict the Need to Initiate Dialysis within Two Years in Patients with Chronic Kidney Disease" International Journal of Molecular Sciences 24, no. 12: 10036. https://doi.org/10.3390/ijms241210036