Prognostic value of plasma myeloperoxidase in ESRD patients

Am J Kidney Dis. 2010 Nov;56(5):937-46. doi: 10.1053/j.ajkd.2010.05.008. Epub 2010 Jul 16.

Abstract

Background: Myeloperoxidase (MPO) has been suggested to have a role in atherosclerosis through its strong oxidative capacity. We hypothesized that MPO level may predict clinical outcomes in patients with end-stage renal disease receiving long-term peritoneal dialysis (PD) therapy.

Study design: Prospective cohort study.

Setting & participants: 236 long-term PD patients were recruited from a single regional dialysis unit in Hong Kong between April 1999 and February 2001.

Predictor: Level of plasma MPO, analyzed using a sandwich enzyme-linked immunosorbent assay.

Outcome & measurement: Mortality and fatal or nonfatal cardiovascular events at 3 years.

Results: The distribution of MPO levels was skewed with a median of 31.8 μg/L (25th-75th percentiles, 24.4-42.7). There were 69 deaths and 81 cardiovascular events. Adjusting for traditional and nontraditional risk factors and C-reactive protein, cardiac troponin T, and N-terminal pro-brain natriuretic peptide levels, a doubling in plasma MPO level was associated independently with a 46% (95% CI, 1.02-2.08; P = 0.04) and 60% (95% CI, 1.17-2.18; P = 0.003) increase in risks of mortality and cardiovascular events, respectively. Log(2)MPO showed significant additional predictive value for mortality (P = 0.04) and cardiovascular events (P = 0.005) when included in Cox regression models consisting of clinical, demographic, dialysis, echocardiographic, and biochemical parameters, as well as C-reactive protein, cardiac troponin T, and N-terminal pro-brain natriuretic peptide levels.

Limitations: MPO was measured at a single time and did not reflect changes over time.

Conclusions: These data suggest that plasma MPO level has significant independent and additional prognostic value beyond the standard clinical, biochemical, and echocardiographic parameters and is useful for outcome stratification in long-term PD patients. MPO may be an important mediator of increased cardiovascular risk in patients with end-stage renal disease and warrants further investigation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Follow-Up Studies
  • Hong Kong / epidemiology
  • Humans
  • Incidence
  • Kidney Failure, Chronic / enzymology*
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Oxidative Stress / physiology
  • Peritoneal Dialysis
  • Peroxidase / blood*
  • Prognosis
  • Prospective Studies
  • Survival Rate / trends

Substances

  • Peroxidase