High serum hyaluronan indicates poor survival in renal replacement therapy

Atherosclerotic cardiovascular disease (CVD), malnutrition, and inflammatio n are common clinical features of chronic renal failure and are associated with increased mortality. Elevated levels of C-reactive protein (CRP) and c ytokines are commonly observed in dialysis patients and have been shown to predict mortality, Serum hyaluronan previously has been used as a marker of apr inflammatory reaction, irrespective of its cause. We have determined s erum levels of albumin and hyaluronan, as well as the prevalence of malnutr ition (subjective global assessment, 2 to 4), inflammation (CRP greater tha n or equal to 10 mg/L), and overt CVD in a cohort of 97 predialysis patient s (52 +/- 13 years). Moreover, we determined the outcome of these patients 29 +/- 11 months after the basal measurement of hyaluronan, Serum levels of hyaluronan (median) were markedly elevated in predialysis patients with si gns of malnutrition (127.1 v 50.5 ng/mL; P < 0.0001), inflammation (130.1 v 55.0 ng/mL; P < 0.0001) and CVD (118.8 v 55.0 ng/mL; P < 0.001), The level s of log hyaluronan correlated significantly to log CRP (R = 0.35; P < 0.00 1), serum albumin (R = -0.40; P < 0.0001), CVD (R = 0.36; P < 0.001), and a ge (R = 0.40; P < 0.0001), respectively. Survival analysis by the Cox regre ssion model showed that elevated hyaluronan levels were, independent of CVD , CRP, and age, significantly related to an increased mortality rate. The c urrent study showed that markedly elevated serum hyaluronan levels are foun d in predialysis patients with malnutrition, inflammation, and CVD and that serum hyaluronan is a risk predictor of poor survival in dialysis, (C) 199 9 by the National Kidney Foundation, Inc.