Association of trimethylamine N-Oxide with cardiovascular and all-cause mortality in hemodialysis patients. Issue 1 (1st January 2020)

• Record Type: Journal Article
• Authors: Zhang, Pan; Zou, Jian-Zhou; Chen, Jun; Tan, Xiao; Xiang, Fang-Fang; Shen, Bo; Hu, Jia-Chang; Wang, Jia-Lin; Wang, Ya-Qiong; Yu, Jin-Bo; Nie, Yu-Xin; Chen, Xiao-Hong; Yu, Jia-Wei; Zhang, Zhen; Lv, Wen-Lv; Xie, Ye-Qing; Cao, Xue-Sen; Ding, Xiao-Qiang
• Is Part Of: Renal failure. Volume 42:Issue 1(2020)
• Page Start: 1004
• Page End: 1014
• Publication Date: 2020-01-01
• Subjects: Uremic toxins -- trimethylamine N-oxide -- cardiovascular mortality -- all-cause mortality -- hemodialysis; Chronic renal failure -- Periodicals; Acute renal failure -- Periodicals; Uremia -- Periodicals; 616.614005
• DOI: 10.1080/0886022X.2020.1822868
• Languages: English
• ISSNs: 0886-022X

Abstract

Abstract: Background: Trimethylamine- N -Oxide (TMAO) is a proatherogenic and prothrombotic metabolite. Our study examined the association of plasma TMAO level with cardiovascular and all-cause mortality in hemodialysis (HD) patients. Methods: Patients who were at least 18 years-old and received HD for at least 6 months were enrolled within 6 months. Patients with coronary heart disease, congestive heart failure, arrhythmia, or stroke within 3 months before study onset were excluded. The primary endpoints were cardiovascular and all-cause death, and the secondary endpoint was cerebrovascular death. Results: We recruited 252 patients and divided them into a high-TMAO group (>4.73 μg/mL) and a low-TMAO group (≤4.73 μg/mL). The median follow-up time was 73.4 months (interquartile range: 42.9, 108). A total of 123 patients died, 39 from cardiovascular disease, 19 from cerebrovascular disease, and 65 from other causes. Kaplan-Meier analysis indicated that the high-TMAO group had a greater incidence of cardiovascular death (Log-Rank: p = 0.006) and all-cause death (Log-Rank: p < 0.001). Cox regression analysis showed that high TMAO level was significantly associated with cardiovascular and all-cause mortality. After adjustment for confounding, this association remained significant for cardiovascular mortality (TMAO as a continuous variable: HR: 1.18, 95%CI: 1.07, 1.294, p < 0.001; TMAO as a dichotomous variable: HR: 3.44, 95%CI: 1.68, 7.08, p < 0.001) and all-cause mortality (TMAO as a continuous variable: HR: 1.14, 95%CI: 1.08, 1.21, p < 0.001; TMAO as a dichotomous variable: HR: 2.54, 95%CI: 1.71, 3.76, p < 0.001). Conclusions: High plasma TMAO level is significantly and independently associated with cardiovascular and all-cause mortality in HD patients.