Higher plasma endothelin-1 levels linked to increased mortality in patients on hemodialysis
Patients on maintenance hemodialysis who had higher levels of plasma endothelin-1 had an increased risk for mortality and hospitalization, according to this study.
According to Ping Li, MD, of Brigham and Women’s Hospital, Harvard Medical School, and colleagues, the endothelium-derived vasoconstrictor peptide known as endothelin-1 aids in the pathogenesis of hypertension, congestive heart failure and inflammation.
All of these, the researchers noted, are “key pathophysiologic features of chronic kidney failure.”
While previous studies have shown associations between endothelin-1 and the aforementioned conditions, Li and colleagues argued that “less is known about whether endothelin-1 is associated with clinical outcomes in patients on HD [hemodialysis], who have an extraordinarily high prevalence of hypertension and vascular disease.”
Using plasma samples assembled by DaVita Clinical Research, the researchers considered time to death and time to hospitalization in 794 patients on hemodialysis (median plasma endothelin-1 level, 2.02). Patients were followed for a median of 28 months. During this time, 32% of the study population died and 81% were hospitalized at least once.
Results showed that, compared with patients in the lowest quartile of plasma endothelin-1 levels, those in the highest quartile had a 2.44-fold higher risk of death and a 1.54-fold higher risk of hospitalization.
The researchers noted that endothelin receptor antagonists have previously been investigated for several conditions including hypertension, congestive heart failure, pulmonary arterial hypertension and diabetic kidney disease.
Therefore, they suggested that, “Although our findings cannot show causality between endothelin-1 and adverse outcomes in patients on maintenance HD, they raise the question of whether endothelin-1 antagonism could be a promising therapeutic approach in treating patients with chronic kidney failure.” – by Melissa J. Webb
Disclosures: Li reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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