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Abstract: FR-PO824

Association Between Endothelin-1 Levels and Mortality Among Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Li, Ping, Harvard Medical School, Boston, United States
  • McCausland, Finnian R., Harvard Medical School, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Harvard Medical School, Boston, Massachusetts, United States
Background

Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide implicated in the pathogenesis of hypertension, heart failure, and CKD. The association of endothelin with adverse outcomes in individuals with end stage renal disease on hemodialysis is unclear.

Methods

We measured pre-dialysis plasma levels of ET-1 in 794 individuals with ESRD on maintenance hemodialysis from the DaVita BioReg Biorepository, a prospective cohort study of prevalent hemodialysis patients. ET-1 was measured with a commercially available ELISA, with CV’s of 7.3% from blind split replicate samples. Unadjusted and adjusted proportional hazards regression models were fit to exam the association of ET-1 with all- cause mortality.

Results

Mean age was 60, 41.4% were women, and median vintage was 37.2 months. Median (IQR) endothelin-1 concentration was 2.02 (1.56 – 2.71) pg/mL. ET-1 levels were positively correlated with pre-dialysis blood pressure (r=0.13, p<0.001), weight difference before and after dialysis (r=0.119, P<0.001) and longer dialysis vintage (r=0.084, P=0.019). In multivariable proportional hazards models adjusted for age, race, sex, BP, BMI, vintage, laboratory variables, and dialysis access, higher ET-1 levels were associated with a 37% higher risk of all-cause mortality (hazard ratio 1.37; 95% confidence interval, 1.23 to 1.53; P < 0.001) during median 27.8 months of follow-up time.

Conclusion

Higher pre-dialysis plasma ET-1 levels are associated with an increased risk of death. The mechanisms underlying this association and its potential therapeutic relevance merit further investigation.