Longitudinal change in endothelial microparticle count is associated with mortality in chronic kidney disease

Darren Green, Sarah Skeoch, Ian Bruce, Yvonne Alexander, Philip Kalra, Benjamin Parker

Research output: Contribution to journalArticlepeer-review

Abstract

Background:   Chronic kidney disease (CKD) is associated with a unique milieu of vascular pathology, and effective biomarkers of active vascular damage are lacking. A candidate biomarker is the quantification of circulating endothelial microparticles (EMP). This study observed longitudinal EMP change (δEMP), and established the association of δEMP with all-cause mortality and cardiovascular events in CKD.

Method:          An observational study in adults with eGFR <60mL/min/1.73m2. EMP were quantified by flow cytometry of platelet poor plasma in 2 samples 12 months apart and categorised as EMP if AnnexinV+/CD31+/CD42b-. Hazard ratios (HR) for time to all-cause mortality and cardiovascular events in patients with above versus below median δEMP, adjusted for age, eGFR, co-morbidities, and blood pressure were calculated using Cox proportional hazard model.

Results:           There were 123 patients with age 63±11 years, systolic blood pressure 135±18 mmHg, eGFR 32±16 mL/min/1.73m2. The median baseline EMP count was 144/μL (range 10-714/μL). The correlation between δeGFR and δEMP was statistically significant (co-efficient 0.20, p = 0.03), and an increase in uPCR was also associated with an increase in EMP (co-efficient 0.21, p=0.02).

The adjusted HR for all-cause mortality in patients with above median δEMP compared to below median δEMP was 2.5 (1.0 – 4.0, p=0.05). There was no association between δEMP and cardiovascular events.

Conclusion:     Longitudinally increasing EMP are associated with mortality in CKD, suggesting that δEMP may have a role as a marker of disease activity or risk in CKD, independent of renal function itself. 
Original languageEnglish
JournalNephron
Early online date2016
Publication statusPublished - 2016

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