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Abstract: TH-PO437

Deoxycholic Acid and Mortality, ESRD, and Cardiovascular Events in Patients with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Frazier, Rebecca, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
  • Cai, Xuan, Northwestern University, Chicago, Illinois, United States
  • Lee, Jungwha, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
  • Jovanovich, Anna Jeanette, Denver VA / University of Colorado, Denver, Colorado, United States
  • Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States
  • Deo, Rajat, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
  • Anderson, Amanda Hyre, Tulane University, New Orleans, Louisiana, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Shafi, Tariq, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Rhee, Eugene P., Massachusetts General Hospital, Newton, Massachusetts, United States
  • Chonchol, Michel, University of Colorado, Aurora, Colorado, United States
  • Miyazaki, Makoto, University of Colorado-Denver, Aurora, Colorado, United States
  • Isakova, Tamara, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
Background

Deoxycholic acid (DCA), a secondary bile acid, is elevated in patients with chronic kidney disease (CKD) and has been linked to vascular calcification in this population. There have not been studies examining the relationship between DCA and adverse events in CKD patients.

Methods

Using data from the prospective Chronic Renal Insufficiency Cohort Study, we analyzed the association between fasting serum DCA levels and death, end-stage renal disease (ESRD), ESRD-censored death and cardiovascular (CV) events in 3147 participants with CKD. We used Tobit regression to determine predictors of high DCA and Cox regression to determine the association between DCA and outcomes.

Results

The average age of participants was 58.9 ± 10.7 years, 40.6% were black, 48.0% had diabetes, and the mean eGFR was 42.5 ± 16.0 ml/min/1.73m2. The independent predictors of elevated DCA were increased age and non-use of statins. Cox regression showed a U-shaped association between log-transformed DCA levels and outcomes. After adjustment, DCA values above the transition points were significantly associated with death, ESRD and ESRD-censored death (HR 1.23, 95% CI 1.04-1.45; HR 1.73, 95% CI 1.13-2.66; HR 1.23, 95% CI 1.00-1.50 respectively). DCA values below the transition points were significantly associated with ESRD (0.87, 95% CI 0.78-0.96). There was no association between DCA and CV events.

Conclusion

DCA is associated with death, ESRD and ESRD-censored death in a U-shaped distribution. DCA levels above the transition points are associated with death, ESRD-censored death, and ESRD in CKD patients, while values below the transition points are associated with ESRD.

Funding

  • NIDDK Support