Cell-free DNA as a marker for the outcome of end-stage renal disease patients on haemodialysis

Susana Coimbra, Susana Rocha, Henrique Nascimento, Maria João Valente, Cristina Catarino, Petronila Rocha-Pereira, Maria Sameiro-Faria, José Gerardo Oliveira, José Madureira, João Carlos Fernandes, Vasco Miranda, Luís Belo, Elsa Bronze-da-Rocha, Alice Santos-Silva, Susana Coimbra, Susana Rocha, Henrique Nascimento, Maria João Valente, Cristina Catarino, Petronila Rocha-Pereira, Maria Sameiro-Faria, José Gerardo Oliveira, José Madureira, João Carlos Fernandes, Vasco Miranda, Luís Belo, Elsa Bronze-da-Rocha, Alice Santos-Silva

Abstract

Background: DNA damage and inflammation are common in end-stage renal disease (ESRD). Our aim was to evaluate the levels of circulating cell-free DNA (cfDNA) and the relationship with inflammation, anaemia, oxidative stress and haemostatic disturbances in ESRD patients on dialysis. By performing a 1-year follow-up study, we also aimed to evaluate the predictive value of cfDNA for the outcome of ESRD patients.

Methods: A total of 289 ESRD patients on dialysis were enrolled in the study: we evaluated cfDNA, haemogram, serum iron, hepcidin, inflammatory and oxidative stress markers, and haemostasis. Events and causes of deaths were recorded throughout the follow-up period.

Results: ESRD patients, as compared with controls, presented significantly higher levels of cfDNA, hepcidin, and inflammatory and oxidative stress markers, and significantly lower values of iron and anaemia-related haemogram parameters. The all-cause mortality rate was 9.7%; compared with alive patients, deceased patients (n =28) were older and presented significantly higher values of inflammatory markers and of cfDNA, which was almost 2-fold higher. Furthermore, cfDNA was the best predictor of all-cause mortality and cardiovascular mortality in ESRD patients, in both unadjusted and adjusted models for basic confounding factors in dialysis.

Conclusions: Our data show cfDNA to be a valuable predictive marker of prognosis in ESRD patients on dialysis treatment; high levels of cfDNA were associated with a poor outcome.

Keywords: CKD outcome; cell-free DNA; end-stage renal disease; inflammation.

© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.

Figures

FIGURE 1:
FIGURE 1:
cfDNA levels for controls and ESRD patients under dialysis therapy and for those who remained alive or were deceased during a 1-year following up period.

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Source: PubMed

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