Low circulating CD34+ cell count is associated with poor prognosis in chronic hemodialysis patients

Abstract

Circulating CD34-positive (CD34(+)) cells, a population that includes endothelial progenitor cells, are believed to contribute to vascular homeostasis. Here we determine the prognostic value of CD34(+) cell measurements in 216 chronic hemodialysis patients. A total of 43 cardiovascular events and 13 deaths occurred over an average 23 months follow-up in this cohort. A cutoff number for circulating CD34(+) cells was determined by receiver operating characteristic curve analysis to maximize the power of the CD34(+) cell count in predicting future cardiovascular events. Based on this, 93 patients were categorized as having low and 123 patients as having high numbers of CD34(+) cells, determined by flow cytometry at the time of enrollment. Both cumulative cardiovascular event-free survival and all-cause survival were significantly less in the group of patients with low numbers of CD34(+) cells. By multivariate analyses, a low level of circulating CD34(+) cells was an independent and significant predictor for both cardiovascular events and all-cause mortality. Our study shows that a reduced number of circulating CD34(+) cells is significantly associated with vascular risks and all-cause mortality in patients on chronic hemodialysis. These cells may be a useful biomarker.

Levels of Circulating Progenitor Cells, Cardiovascular Outcomes and Death

“…All meta-analyzed studies included patients at a high cardiovascular risk at baseline, mostly in secondary prevention, and 5 studies enrolled only patients with acute CVD, who have the highest short-term cardiovascular risk. As the CPC/EPC enumeration is usually by guest on May 11, 2018 http://circres.ahajournals.org/ performed on fresh samples, to yield a sufficient statistical power in the analysis of event-free survival with relatively small sample size and short follow-up, high-risk patients need to be enrolled. Because biomarkers perform better in high-risk than in low-risk populations, 3,49 whether the levels of CPCs/EPCs provide prognostic information also in the general population remains unclear.…”

“…[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.…”

“…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.…”

The Prevelance and Related Risk Factors of Intradialytic Hypertension in Hemodialysis Patients

“…Diyaliz öncesi ve postdiyalitik kardiyak çıktı değişikliklerinin her iki grupta benzer olduğunu ancak NDH'nin İDHT'li hastalarda %57, kontrol grubunda ise %17,7 oranında arttığı gösterilmiştir (19). İntradiyalitik HT'ye eşlik eden bu durumun endotelin-1(ET-1) ve nitrik oksit (NO) arasındaki dengenin endotel disfonksiyonu nedeniyle bozulmasına bağlı olabileceği düşünülmüştür (20)(21)(22).…”

A Look at the Bone Marrow Predicts the Global Outcome

“…It should be noted that 4 previous longitudinal studies assessed the prognostic role of PB stem/ progenitor cell phenotypes: of these, 2 reported an association between reduced CD34 + cells and all-cause mortality 6,7 ( Table). Combining those data with Patel et al's 5 finding yields a pooled hazard ratio of death from any cause of 2.78 (95% CI, 1.29-7.37) for low versus high CD34…”