Serum lipopolysaccharide‐binding protein levels and cardiovascular events in hemodialysis patients: A prospective cohort study. Issue 11 (14th September 2022)

• Record Type: Journal Article
• Authors: Lin, Ting‐Yun; Chang, Yu‐Kang; Wu, Ming‐Yin; Wu, Tsai‐Kun; Chen, Chang‐Hsu; Lim, Paik‐Seong
• Is Part Of: Nephrology. Volume 27:Issue 11(2022)
• Page Start: 877
• Page End: 885
• Publication Date: 2022-09-14
• Subjects: cardiovascular event -- endotoxemia -- haemodialysis -- inflammation -- lipopolysaccharide‐binding protein; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.14107
• Languages: English
• ISSNs: 1320-5358

Abstract

Abstract: Introduction: Patients with end‐stage kidney disease (ESKD) exhibit an elevated cardiovascular risk. Chronic inflammation is one of the main mechanisms of cardiovascular disease (CVD). Lipopolysaccharide has been proposed as a link between systemic inflammation and CVD. Herein, we evaluated whether lipopolysaccharide‐binding protein (LBP), a surrogate marker of lipopolysaccharide and consequent inflammation, is associated with cardiovascular events in ESKD. Methods: We performed a prospective cohort study of maintenance haemodialysis patients. Baseline serum LBP levels were categorized into tertiles and also modelled continuously for analyses. Cox regression methods were used to evaluate the association of serum LBP levels with cardiovascular events. Results: A total of 360 haemodialysis patients were included in this analysis. During a median follow‐up of 3.1 years, 90 (25.0%) patients had cardiovascular events. Patients in the upper tertile of serum LBP levels had a significantly greater risk of cardiovascular events [hazard ratio (HR) 4.87; 95% confidence intervals (CI), 2.12–11.15] than those in the lower tertile, independent of age, sex, hypertension, diabetes, CVD, dialysis vintage, body mass index, non–high‐density lipoprotein cholesterol, albumin, phosphorus, high‐sensitivity C‐reactive protein, and interleukin‐6. The association was consistent regardless of whether competing risk of death was accounted for (subdistribution HR 4.87; 95% CI, 1.96–12.11 for upper versus lower tertiles) or serum LBP was analysed as a continuous variable (HR 1.30; 95% CI, 1.02–1.66 per 1 SD increment). Conclusions: Serum LBP levels were independently associated with cardiovascular events in heomodialysis patients. LBP might serve as a novel biomarker for CVD in ESKD. Summary at a glance: In this prospective study of haemodialysis patients, baseline levels of lipopolysaccharide‐binding protein (LBP), a surrogate marker of lipopolysaccharide and consequent inflammation, were independently associated with risk of cardiovascular events. The result suggests that LBP might serve as a novel biomarker for cardiovascular disease in end‐stage kidney disease.