Kidney Week

Abstract: FR-PO0517

Ang2/Ang1 Ratio as an Independent Cardiovascular Risk Predictor in Patients with Hypertension and CKD

Session Information

• CKM: Clinical - Trials, Epidemiology, and Biomarkers
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Kim, Jeeyoung, Chung Ang University Hospital, Dongjak-gu, Seoul, Korea (the Republic of)

Jeeyoung Kim, MD

• Kim, Minsang, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)

Minsang Kim, MD

• Kang, Eunjeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Eunjeong Kang, MD, PhD

• Oh, Kook-Hwan, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)

Kook-Hwan Oh, MD, PhD

• Kim, Yon Su, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)

Yon Su Kim, MD, PhD

• Yang, Seung Hee, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Seung Hee Yang, PhD

• Lee, Hajeong, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)

Hajeong Lee, MD, PhD

Background

Endothelial dysfunction underlies progressive glomerular injury in CKD. Within the Angiopoietin (Ang)-Tie2 axis, Ang2 competitively antagonizes Ang1, impairing endothelial Tie2 signaling. Whether the Ang2/Ang1 ratio and circulating soluble Tie2 (sTie2) predict renal and cardiovascular outcomes in CKD remains unexplored in a large prospective cohort.

Methods

We analyzed stage 1–3B CKD patients (excluding polycystic kidney disease) from KNOW-CKD, a nationwide prospective longitudinal registry. Serum Ang1, Ang2, and sTie2 were measured by ELISA. The primary endpoint was major adverse cardiovascular events (MACE); secondary endpoints included all-cause mortality and renal progression (≥50% eGFR reduction, creatinine doubling, or kidney failure). The hypertensive subgroup was defined as patients taking ≥2 antihypertensive medications.

Results

Among 1,186 CKD patients, 137 were classified as stage 1, 312 as stage 2, 306 as stage 3a, and 431 as stage 3b. During a median follow-up of 9.5 years, 67 MACE, 379 renal progression events, and 104 all-cause deaths were observed. The Ang2/Ang1 ratio increased progressively with CKD stage. Although it did not differ significantly between hypertensive and non-hypertensive patients overall (p=0.106), this stage-dependent increase was observed only in the hypertensive subgroup (n=685). In addition, the Ang2/Ang1 ratio was elevated in patients who experienced MACE, renal events, and all-cause mortality, particularly in the hypertensive subgroup. In multivariable Fine-Gray competing risk regression, a higher Ang2/Ang1 ratio was independently associated with MACE in hypertensive CKD after adjusting for age, sex, baseline eGFR, UACR, hemoglobin, and albumin.

Conclusion

The Ang2/Ang1 ratio increases with CKD progression and predicts adverse cardiovascular and renal outcomes in hypertensive CKD patients. Its independent association with MACE, particularly in the hypertensive subgroup, suggests the Ang2/Ang1 ratio may help identify high-risk CKD patients beyond conventional markers.