Endothelial Progenitor Cells Predict Long-Term Mortality in Hemodialysis Patients

Abstract

Background: The endothelial progenitor cells (EPCs) dysfunction is a critical event in the initiation of atherosclerotic plaque development and the level of circulating EPCs can be considered a biomarker of cardiovascular events. The level and functional change in EPCs has been investigated in hemodialysis patients, but the effect of absolute number of EPCs on risk of death has not yet been explored. We hypothesized that the number of EPCs predicted death from cardiovascular and all-cause mortality in hemodialysis patients.Methods: We evaluate the association between endothelial progenitor cells and clinical outcome in 154 patients on maintenance hemodialysis. The blood sample was drawn at the time of patient enrollment and EPCs were identified by flow cytometry using triple staining for CD34/CD133/KDR.Results: The median duration of follow-up was 4.19 years. There were 79 (51.3%) deaths during the follow-up period, 41 of whom died due to a confirmed cardiovascular cause. The cumulative survival was greater in the high-EPC group than the low-EPC group for all-cause and cardiovascular mortality. Decreased EPCs levels were associated with a significant increase in the risk of cardiovascular and all-cause mortality after adjusting for age, gender, current smokers, diabetes mellitus, and hypertension.Conclusions: The level of circulating EPCs independently predicts the clinical outcome in patients on maintenance hemodialysis. Thus, the EPCs levels may be a useful predictive tool for evaluating the risk of death in maintenance hemodialysis patients.

Levels of Circulating Progenitor Cells, Cardiovascular Outcomes and Death

“…Four of the 21 studies (n=512 patients, 12.8% of the total population) were conducted in patients with acute coronary syndrome, acute myocardial infarction, or stroke. 20,25,27,34 For the remainders, the underlying disease or condition was elective percutaneous intervention in 7 of 17 studies (n=795 patients; 19.1%), [17][18][19]22,29,31,33 elective coronary angiography for suspected coronary artery disease in 2 of 17 (n=1412 patients; 34.0%), 28,32 end-stage renal disease in 4 of 17 studies (n=705 patients; 17.0%), 23,24,26,35 chronic heart failure in 1 of 17 studies (n=156 patients; 3.8%), 16 and aortic stenosis in 1 of 17 study (n=261 patients; 6.3%). 35 One study included patients with and without chronic CVD at baseline, 21 and 1 study included both healthy subjects and patients with chronic or acute CVD.…”

“…[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Characteristics of studies included from meta-analysis are given in the Table. The most important reason whereby studies initially retrieved were finally excluded from meta-analysis was the lack of a poolable risk estimate and impossibility to calculate such estimate from the data provided (Online Table III). Pooled cumulative clinical characteristics of the metaanalyzed patient population are reported in Online Table IV.…”

The Role of Vitamin D in Modulating Mesenchymal Stem Cells and Endothelial Progenitor Cells for Vascular Calcification

“…For example, in patients with end-stage renal disease, EPCs with surface markers of CD34+/CD133−/KDR+/CD45− were activated by active vitamin D, which lowered the expression of osteocalcin [79]. Furthermore, the concentration of circulating endothelial cells with markers of CD34+/CD133+/KDR+ can predict cardiovascular mortality in patients with atherosclerosis and those requiring hemodialysis [80]. However, EPCs bearing the markers CD34+/CD133+/VEGFR+ can enable vasculogenesis [81].…”

Older men display elevated levels of senescence-associated exercise-responsive CD28nullangiogenic T cells compared with younger men

“…), and reduced circulating number of EPCs in older individuals is highly predictive of mortality (Lu et al. ; Samman Tahhan et al. ).…”

“…Circulating cells play a significant role in maintaining endothelial homeostasis. Such cells include endothelial progenitor cells (EPCs), which have been found to be reduced in number in the circulation of older individuals (Thijssen et al 2006;Ross et al 2018), and reduced circulating number of EPCs in older individuals is highly predictive of mortality (Lu et al 2016;Samman Tahhan et al 2017).…”