Prognostic value of serum von Willebrand factor, but not soluble ICAM and VCAM, for mortality and cardiovascular events is independent of residual renal function in peritoneal dialysis patients

Abstract

Objective: We explored associations between markers of endothelial dysfunction and outcome events, and whether those associations were independent of residual renal function (RRF) in patients on peritoneal dialysis.

Methods: The study enrolled 261 incident patients and 68 healthy control subjects who were followed till death, censoring, or study end. Demographics, biochemistry, markers of inflammation (C-reactive protein) and endothelial dysfunction [soluble intercellular adhesion molecule 1 (sICAM), soluble vascular adhesion molecule 1 (sVCAM), and von Willebrand factor (vWf)] were examined at baseline. Outcome events included all-cause death and fatal and nonfatal cardiovascular (CV) events.

Results: Mean levels of vWf, sICAM, and sVCAM were significantly higher in patients than in healthy control subjects. Levels of sICAM and sVCAM, but not vWf, were significantly correlated with RRF. Levels of sICAM and vWf both predicted all-cause mortality and fatal and nonfatal CV events after adjustment for recognizable CV risk factors. The association between sICAM and outcome events disappeared after further adjustment for RRF. However, RRF did not change the predictive role of vWf for outcome events. Compared with the lowest vWf quartile (6.6% - 73.9%), the highest vWf quartile (240.9% - 1161%) predicted the highest risk for fatal and nonfatal CV events (adjusted hazard ratio: 2.05; 95% confidence interval: 1.15 to 3.64; p = 0.014). We observed no associations between sVCAM and RRF, or sVCAM and any outcome event.

Conclusions: The prognostic value of vWf, but not sICAM, is independent of RRF in predicting mortality and CV events.

Keywords: Cardiovascular mortality; sICAM; sVCAM; soluble intercellular adhesion molecule 1; soluble vascular adhesion molecule 1; vWf; von Willebrand factor.

Figure 1 —

Adjusted hazard ratios (HRs) for fatal and nonfatal cardiovascular events by quartile of von Willebrand factor (vWf), determined using Cox proportional hazards regression models. Adjusted variables were age, sex, body mass index, diabetes, background cardiovascular disease, baseline mean arterial pressure, hemoglobin, serum phosphate, residual renal function, and low-density lipoprotein cholesterol. Compared with the first quartile of vWf, the fourth quartile had an adjusted HR for fatal and nonfatal cardiovascular events of 2.05 (95% confidence interval: 1.15 to 3.64; p = 0.014).