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Abstract: PO0944

Circulating Microbiome and Cardiovascular Death in Patients with ESRD

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Pierre, Joseph F., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Han, Zhongji, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Mims, Tahliyah S., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Datta, Susmita, University of Florida, Gainesville, Florida, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Patients with end-stage renal disease (ESRD) suffer from disproportionately high cardiovascular (CV) mortality. Accumulating evidence suggests a role for the circulating microbiome (CM) in the pathogenesis of CV disease; however, little is known about its association with premature CV mortality in ESRD.

Methods

In a pilot case-control study of 17 hemodialysis (HD) patients who died of a CV event and 17 matched HD controls who remained alive during a median follow-up period of 2.0 years, we compared the levels and composition of CM, including Bacteria, Archaea, and Fungi in serum samples by quantitative PCR and 16S or Internal Transcribed Spacer (ITS) ribosomal RNA (rRNA) sequencing, respectively. Association of the CM with CV death were examined using multivariable conditional logistic regression.

Results

16S and ITS rRNA was detectable in all (except 3 for ITS) examined patients’ serum samples. Despite no significant difference in 16S rRNA levels and α diversity between cases and controls, taxonomic analysis demonstrated differential community membership between groups, with significantly greater Actinobacteria and less Proteobacteria observed in cases than controls at the phylum level. At the genus level, Staphylococcus was numerically higher in cases than in controls, albeit not reaching statistical significance. Proportions of Actinobacteria and Proteobacteria phyla were marginally associated with risk of cardiovascular death (adjusted ORs [95% CI], 1.12 [0.98-1.29] and 0.88 [0.76-1.02] for 1% increase, respectively; Table). Although circulating fungal community α diversity was significantly elevated in cases than controls, no significant association was observed with CV death.

Conclusion

Alterations of the CM may be associated with a higher risk of premature CV mortality in ESRD patients.

Association of circulating microbiome with cardiovascular death in hemodialysis patients
CharacteristicsAdjusted Odds Ratio95% CI
16S rRNA (per log10 ng/uL)0.380.002 to 85.7
Shannon Index (per unit)0.920.17 to 4.92
Actinobacteria (per percent)1.120.98 to 1.29
Proteobacteria (per percent)0.880.76 to 1.02

Model was adjusted for age, sex, race, dialysis vintage, and vascular access type.

Funding

  • NIDDK Support