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Abstract: SA-PO932

The Association Between TMAO, CMPF, and Clinical Outcomes in Advanced CKD: Results From the EQUAL Study

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Dai, Lu, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Massy, Ziad, Centre Hospitalier Universitaire Ambroise Pare, Boulogne-Billancourt, France
  • Stenvinkel, Peter, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Chesnaye, Nicholas C., Universiteit van Amsterdam, Amsterdam, Netherlands
  • Larabi, Islam Amine, Universite de Versailles Saint-Quentin-en-Yvelines, Versailles, Île-de-France, France
  • Alvarez, Jean-claude, Universite de Versailles Saint-Quentin-en-Yvelines, Versailles, Île-de-France, France
  • Caskey, Fergus, University of Bristol, Bristol, Bristol, United Kingdom
  • Torino, Claudia, Universita degli Studi Mediterranea di Reggio Calabria, Reggio Calabria, Italy
  • Porto, Gaetana, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Calabria , Italy
  • Szymczak, Maciej, Uniwersytet Medyczny im Piastow Slaskich we Wroclawiu, Wroclaw, Dolnoslaskie, Poland
  • Krajewska, Magdalena, Uniwersytet Medyczny im Piastow Slaskich we Wroclawiu, Wroclaw, Dolnoslaskie, Poland
  • Drechsler, Christiane, Universitatsklinikum Wurzburg Medizinische Klinik und Poliklinik II Abteilung fur Molekulare Innere Medizin, Wurzburg, Bayern, Germany
  • Wanner, Christoph, Universitatsklinikum Wurzburg Medizinische Klinik und Poliklinik II Abteilung fur Molekulare Innere Medizin, Wurzburg, Bayern, Germany
  • Jager, Kitty J., Universiteit van Amsterdam, Amsterdam, Netherlands
  • Dekker, Friedo W., Universiteit van Amsterdam, Amsterdam, Netherlands
  • Evenepoel, Pieter, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
  • Evans, Marie, Karolinska Institutet, Stockholm, Stockholm, Sweden
Background

Trimethylamine N-oxide (TMAO), a metabolite from red meat and fish consumption, plays a role in promoting cardiovascular events. However, data regarding TMAO and its impact on clinical outcomes are inconclusive, possibly due to its undetermined dietary source. We hypothesized circulating TMAO derived from fish intake might cause less harm compared to red meat by examining the concomitant level of 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF), a known biomarker of fish intake, and investigated the association between TMAO, CMPF and outcomes in CKD.

Methods

Patients were recruited from the European QUALity study on treatment in CKD (EQUAL) among patients (≥65 years) whose eGFR had dropped for the first time to ≤20mL/min/1.73m2 during last 6 months. The association between TMAO, CMPF and outcomes including all-cause mortality and kidney replacement therapy (KRT) was assessed among 824 patients. Patients were further stratified by median cut-offs of TMAO and CMPF, suggesting high/low red meat and fish intake.

Results

Higher TMAO was independently associated with an increased risk of all-cause mortality (multivariable-hazard ratio (HR) 1.41, 95% CI) 1.15-1.74). Higher CMPF was associated with a reduced risk of both all-cause mortality (HR 0.80, 95%CI 0.71-0.89) and KRT (HR 0.83, 95%CI 0.74-0.93), independent of TMAO and other confounders. In comparison to patients with low TMAO and CMPF, patients with low TMAO and high CMPF had reduced risk of all-cause mortality (adjusted HR 0.50, 95% CI 0.33-0.75), and those with high TMAO and high CMPF had a non-significant association with mortality risk (Figure1).

Conclusion

High CMPF conferred an independent role in health benefits and might even counteract the unfavorable effect of TMAO on outcomes. Whether higher circulating CMPF are due to fish consumption, and/or CMPF is a protective marker remain to be demonstrated by further studies.