Inflammatory markers and risk of cerebrovascularevents in patients initiating dialysis

Stephen M Sozio, Josef Coresh, Bernard Jaar, Nancy E. Fink, Laura C. Plantinga, Paige A. Armstrong, J. Craig Longenecker, A. Richey Sharrett, Neil R. Powe, Rulan S. Parekh

Research output: Contribution to journalArticle

Abstract

Background and objectives Stroke remains a leading cause of morbidity and mortality for patients on dialysis;however, its risk factors in this population and measures to prevent it are not well understood.Design, setting, participants, & measurements We investigated whether inflammation was associated withcerebrovascular events in a national US cohort of 1041 incident dialysis patients enrolled from October 1995to June 1998 and followed until January 31, 2004. Incident cerebrovascular events were defined as nonfatal(hospitalized stroke, carotid endarterectomy) and fatal (stroke death) events after dialysis initiation. WithCox proportional hazards regression analysis accounting for the competing risk of nonstroke death, we assessedthe independent event risk associated with baseline levels of multiple inflammatory markers (highsensitivityC-reactive protein [hsCRP], interleukin-6 (IL-6), matrix metalloproteinase-3 [MMP-3], and P-selectin)and hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) use, which mayhave pleiotropic inflammatory effects.Results 165 patients experienced a cerebrovascular event during 3548 person-years of follow-up; overall incidencerate was 4.9/100 person-years. None of the inflammatory markers were associated with cerebrovascularevent risk (adjusted hazard ratios [HRs] per log unit [95% confidence interval]: hsCRP, 0.97 [0.85 to1.11]; IL-6, 1.04 [0.85 to 1.26]; MMP-3, 1.02 [0.70 to 1.48]; P-selectin, 0.98 [0.57 to 1.68]). Statin use was alsonot associated with significant risk of events in unadjusted (HR 1.07 [0.69 to 1.68]) or propensity-score adjustedanalyses (HR 0.98 [0.61 to 1.56]).Conclusions In conclusion, neither inflammatory markers nor statin use was associated with risk of cerebrovascularevents. Further studies are needed to understand the pathophysiology and prevention of stroke inpatients on dialysis.

Original languageEnglish (US)
Pages (from-to)1292-1300
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number6
DOIs
StatePublished - Jun 1 2011

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Dialysis
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Stroke
Matrix Metalloproteinase 3
P-Selectin
Interleukin-6
Propensity Score
Carotid Endarterectomy
Coenzyme A
Inpatients
Oxidoreductases
Proteins
Regression Analysis
Confidence Intervals
Inflammation
Morbidity
Mortality
Population

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Inflammatory markers and risk of cerebrovascularevents in patients initiating dialysis. / Sozio, Stephen M; Coresh, Josef; Jaar, Bernard; Fink, Nancy E.; Plantinga, Laura C.; Armstrong, Paige A.; Longenecker, J. Craig; Sharrett, A. Richey; Powe, Neil R.; Parekh, Rulan S.

In: Clinical Journal of the American Society of Nephrology, Vol. 6, No. 6, 01.06.2011, p. 1292-1300.

Research output: Contribution to journalArticle

Sozio, Stephen M ; Coresh, Josef ; Jaar, Bernard ; Fink, Nancy E. ; Plantinga, Laura C. ; Armstrong, Paige A. ; Longenecker, J. Craig ; Sharrett, A. Richey ; Powe, Neil R. ; Parekh, Rulan S. / Inflammatory markers and risk of cerebrovascularevents in patients initiating dialysis. In: Clinical Journal of the American Society of Nephrology. 2011 ; Vol. 6, No. 6. pp. 1292-1300.
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abstract = "Background and objectives Stroke remains a leading cause of morbidity and mortality for patients on dialysis;however, its risk factors in this population and measures to prevent it are not well understood.Design, setting, participants, & measurements We investigated whether inflammation was associated withcerebrovascular events in a national US cohort of 1041 incident dialysis patients enrolled from October 1995to June 1998 and followed until January 31, 2004. Incident cerebrovascular events were defined as nonfatal(hospitalized stroke, carotid endarterectomy) and fatal (stroke death) events after dialysis initiation. WithCox proportional hazards regression analysis accounting for the competing risk of nonstroke death, we assessedthe independent event risk associated with baseline levels of multiple inflammatory markers (highsensitivityC-reactive protein [hsCRP], interleukin-6 (IL-6), matrix metalloproteinase-3 [MMP-3], and P-selectin)and hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) use, which mayhave pleiotropic inflammatory effects.Results 165 patients experienced a cerebrovascular event during 3548 person-years of follow-up; overall incidencerate was 4.9/100 person-years. None of the inflammatory markers were associated with cerebrovascularevent risk (adjusted hazard ratios [HRs] per log unit [95{\%} confidence interval]: hsCRP, 0.97 [0.85 to1.11]; IL-6, 1.04 [0.85 to 1.26]; MMP-3, 1.02 [0.70 to 1.48]; P-selectin, 0.98 [0.57 to 1.68]). Statin use was alsonot associated with significant risk of events in unadjusted (HR 1.07 [0.69 to 1.68]) or propensity-score adjustedanalyses (HR 0.98 [0.61 to 1.56]).Conclusions In conclusion, neither inflammatory markers nor statin use was associated with risk of cerebrovascularevents. Further studies are needed to understand the pathophysiology and prevention of stroke inpatients on dialysis.",
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T1 - Inflammatory markers and risk of cerebrovascularevents in patients initiating dialysis

AU - Sozio, Stephen M

AU - Coresh, Josef

AU - Jaar, Bernard

AU - Fink, Nancy E.

AU - Plantinga, Laura C.

AU - Armstrong, Paige A.

AU - Longenecker, J. Craig

AU - Sharrett, A. Richey

AU - Powe, Neil R.

AU - Parekh, Rulan S.

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N2 - Background and objectives Stroke remains a leading cause of morbidity and mortality for patients on dialysis;however, its risk factors in this population and measures to prevent it are not well understood.Design, setting, participants, & measurements We investigated whether inflammation was associated withcerebrovascular events in a national US cohort of 1041 incident dialysis patients enrolled from October 1995to June 1998 and followed until January 31, 2004. Incident cerebrovascular events were defined as nonfatal(hospitalized stroke, carotid endarterectomy) and fatal (stroke death) events after dialysis initiation. WithCox proportional hazards regression analysis accounting for the competing risk of nonstroke death, we assessedthe independent event risk associated with baseline levels of multiple inflammatory markers (highsensitivityC-reactive protein [hsCRP], interleukin-6 (IL-6), matrix metalloproteinase-3 [MMP-3], and P-selectin)and hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) use, which mayhave pleiotropic inflammatory effects.Results 165 patients experienced a cerebrovascular event during 3548 person-years of follow-up; overall incidencerate was 4.9/100 person-years. None of the inflammatory markers were associated with cerebrovascularevent risk (adjusted hazard ratios [HRs] per log unit [95% confidence interval]: hsCRP, 0.97 [0.85 to1.11]; IL-6, 1.04 [0.85 to 1.26]; MMP-3, 1.02 [0.70 to 1.48]; P-selectin, 0.98 [0.57 to 1.68]). Statin use was alsonot associated with significant risk of events in unadjusted (HR 1.07 [0.69 to 1.68]) or propensity-score adjustedanalyses (HR 0.98 [0.61 to 1.56]).Conclusions In conclusion, neither inflammatory markers nor statin use was associated with risk of cerebrovascularevents. Further studies are needed to understand the pathophysiology and prevention of stroke inpatients on dialysis.

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