Key result
Elevated baseline serum Angiopoietin-2 concentrations were independently associated with a significantly higher risk of all-cause mortality in male hemodialysis patients (HR 3.294), but not in females.
Why the study?
Pathological vascular remodeling and angiogenesis involve Ang-2 and are active in ESRD, potentially contributing to high mortality, but the ability of baseline serum Ang-2 to predict all-cause mortality in hemodialysis patients was unclear.
Do baseline serum Ang-2 concentrations predict all-cause mortality in ESRD patients on hemodialysis?
Cohort (n=313)
Yes
Do baseline serum Ang-2 concentrations predict all-cause mortality in ESRD patients on hemodialysis?
Baseline serum Angiopoietin-2 is a strong independent predictor of all-cause mortality in male, but not female, patients with end-stage renal disease on hemodialysis.
BACKGROUND: Angiopoietin-2 (Ang-2) plays a pivotal role in pathological vascular remodeling and angiogenesis. Both vascular mechanisms are active in patients with end-stage renal disease (ESRD) and may contribute to the high mortality in these patients. The aim of this multicenter prospective cohort study was to investigate baseline serum Ang-2 concentrations in ESRD patients on hemodialysis (HD) for their ability to predict all-cause mortality. METHODS: We conducted a prospective cohort study in 340 stable HD patients from different chronic dialysis centers in Berlin, Germany. The primary endpoint was all-cause mortality during a 5-year follow-up period. Blood samples and clinical data were collected at baseline. Serum Ang-2 was measured with a validated enzyme-linked immunosorbent assay (Biomedica, Vienna, Austria). RESULTS: A total of 313 HD patients (206 men and 107 women) were finally included in the study. Receiver operating characteristic (ROC) analysis of Ang-2 concentrations yielded an area under the curve (AUC) of 0.65 (P < 0.0001) for predicting all-cause mortality in the entire study population and was used to determine the optimal cut-off (111.0 pmol/L) for all-cause mortality. Kaplan-Meier survival analysis indicated that male but not female end-stage kidney disease patients on HD with higher Ang-2 concentrations had a significantly lower survival (log-rank test, P < 0.0001 and P = 0.380 for male and female patients, respectively). Multivariable Cox regression analyses adjusted for age, comorbidity, smoking, dialysis vintage, serum creatinine, hemoglobin, C-reactive protein, serum albumin, intact parathyroid hormone (iPTH), low-density lipoprotein (LDL) and Kt/V likewise indicated that elevated Ang-2 concentrations are associated with all-cause mortality in male {hazard ratio [HR] 3.294 [95% confidence interval (CI) 1.768-6.138]; P = 0.0002} but not in female end-stage kidney disease patients on HD [HR 1.084 (95% CI 0.476-2.467); P = 0.847]. CONCLUSION: Ang-2 at baseline is independently associated with all-cause mortality in male ESRD patients on HD.
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Chu et al. (2021) conducted a cohort in End-stage kidney disease on hemodialysis (n=313). Elevated baseline serum Angiopoietin-2 (≥111.0 pmol/L) vs. Angiopoietin-2 <111.0 pmol/L was evaluated on All-cause mortality (HR 3.294, 95% CI 1.768-6.138, p=0.0002). Elevated baseline serum Angiopoietin-2 concentrations were independently associated with a significantly higher risk of all-cause mortality in male hemodialysis patients (HR 3.294), but not in females.
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