Background and aims: Calciprotein particles (CPPs), nano-aggregates containing fetuin-A-bound calcium-phosphate, are associated with aortic stiffness and coronary calcification in maintenance hemodialysis patients. A novel gel-filtration assay can detect low-density small CPPs, which are actually a major form of circulating CPPs in vivo. We sought to investigate whether circulating CPP levels measured by gel-filtration method would accurately predict hard endpoints in maintenance hemodialysis patients.
Methods: This study used a prospective, multicenter, longitudinal, and observational design. One-hundred eight patients enrolled in this study were followed-up for about 2 years. We reported all-cause death and cardiovascular events, which included major adverse cardiac, cerebrovascular, and limb events.
Results: Kaplan-Meier analysis showed no significant difference between patients with the higher (>median) and lower (<median) CPP levels with regard to all-cause death. However, the higher CPP group showed a higher incidence of cardiovascular events (log-rank test χ2 = 4.41, p = 0.036). Univariate Cox regression analysis revealed that CPP levels were not associated with all-cause death, but were significantly associated with higher incidence of cardiovascular events (hazard ratio (HR) 1.03, 95% confidence interval (CI) [1.02-1.05], p < 0.001) for every thousand CPP increase. Multivariate Cox regression analysis revealed that CPP levels were not associated with all-cause death, but were independently associated with cardiovascular events (HR 1.03, 95% CI [1.01-1.04], p < 0.001) for every thousand CPP.
Conclusions: This finding suggests a potential predictive value of CPPs in maintenance hemodialysis patients.
Keywords: Calciprotein particle (CPP); Gel filtration method; Vascular calcification.
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