Serum Endocan Levels and Subclinical Atherosclerosis in Patients with Chronic Kidney and End-Stage Renal Diseases

Abstract

Background and Aim. Chronic kidney disease (CKD) and its final stage: end-stage renal disease (ESRD), are common clinical conditions. Endocan is a human endothelial cell-specific molecule produced by endothelial cells. Its production is related to activation of endothelium and angiogenesis. In this study, we assessed the relation between serum endocan levels and subclinical atherosclerosis (SCA) in CKD and hemodialysis (HD) patients. Subjects and Methods. The present case control study enrolled 30 patients on regular HD for at least 6 months, 30 patients with CKD, and 30 age and sex-matched healthy controls. All participants were subjected to careful history taking and thorough clinical examination. Laboratory investigations included complete blood count, kidney functions, and serum cholesterol, triglycerides, calcium, phosphorus, albumin, PTH, hsCRP, and endocan levels. Results. HD and CKD groups had significantly higher endocan levels when compared with control group (median (IQR): 519.0 (202.3–742.0) versus 409.0 (245.3–505.3) and 273.0 (168.0–395.5) ng/L, respectively). Also, HD patients had significantly higher endocan levels when compared with CKD levels. HD patients had significantly higher carotid intima-media thickness (CIMT) when compared with CKD patients (median (IQR): 0.80 (0.80–0.90) versus 0.75 (0.73–0.75) mm, p < 0.001 ). HD patients had significantly higher frequency of SCA when compared with CKD patients (46.7% versus 13.3%, p = 0.005 ). Patients with SCA had significantly higher hsCRP (median (IQR): 36.5 (26.8–43.5) versus 24.0 (15.8–29.0) mg/dl) and endocan levels (697.0 (528.3–974.8) versus 222.5 (158.8–565.8) ng/L) when compared with patients without SCA. ROC curve analysis of endocan for identification of SCA in HD patients showed that at a cutoff of 380.5 ng/L, endocan has an AUC of 0.862 with a sensitivity and specificity of 92.9% and 68.7%, respectively. Conclusions. Serum endocan levels are related to SCA in HD patients. In addition, it is associated with the hyperinflammatory state in those patients.

The Role of Endocan in Cardiometabolic Disorders

“…An early cross-sectional study enrolling 251 patients with chronic kidney disease (CKD), stages 1–5, and 60 controls published almost a decade ago suggested that: (1) circulating endocan levels are significantly higher among subjects with CKD compared to the controls, (2) endocan levels are progressively higher across advanced stages of CKD, and (3) the circulating endocan levels among subjects with CKD are significantly correlated with inflammatory markers and indices of endothelial dysfunction, suggesting that it might be an important predictor of all-cause death among this specific population [ 17 ]. Similar results were obtained from another, recently published observational study which enrolled 30 patients with CKD stage 5 under hemodialysis, 30 patients with CKD not receiving hemodialysis, and 30 controls, which confirmed a strong relationship between endocan levels and the stage of CKD [ 69 ]. The interconnection between endocan levels, systemic inflammation, subclinical atherosclerosis, and endothelial dysfunction was also confirmed [ 69 ].…”

“…Similar results were obtained from another, recently published observational study which enrolled 30 patients with CKD stage 5 under hemodialysis, 30 patients with CKD not receiving hemodialysis, and 30 controls, which confirmed a strong relationship between endocan levels and the stage of CKD [ 69 ]. The interconnection between endocan levels, systemic inflammation, subclinical atherosclerosis, and endothelial dysfunction was also confirmed [ 69 ].…”

High circulating endocan in chronic kidney disease? A systematic review and meta-analysis

“…Overall, our meta-analysis included 696 CKD patients and 335 controls from eight studies [ 3 , 9 – 11 , 21 , 22 , 26 , 31 ]. The meta-analysis of these studies revealed significantly higher circulating Endocan levels in CKD patients (SMD 1.34, 95% CI 0.20 to 2.48, p-value<0.01, Fig 2 ).…”

“…The comparison of endocan levels between CKD patients on regular hemodialysis (HD) and non-dialyzed CKD patients was done in two studies [ 22 , 31 ]. Samouilidou et al [ 31 ] evaluated serum endocan in CKD patients with or without HD.…”

“…They found that serum endocan levels were significantly higher among HD patients in comparison with CKD without HD patients (146 [46 – 337] pg/ml vs. 86 [26 – 207] pg/ml, p-value < 0.001). Also, El-Senosy et al [ 22 ] aimed to compare serum endocan levels in CKD without HD and CKD with HD participants and found significantly higher endocan in CKD with HD compared to CKD without HD participants (519.0 [202.3–742.0] vs. 409.0 [245.3–505.3], P = 0.014). Also, HD patients had a significantly higher percentage of subclinical atherosclerosis compared to CKD patients without HD (46.7% vs. 13.3%, p-value = 0.005).…”