1. Home
  2. Vol 53, No 1 (2021)
  3. Ginanjar

The Association of b2-Microglobulin and Fibroblast Growth Factor 23 with Major Adverse Cardiac Event in Acute Coronary Syndrome Patients with Chronic Kidney Disease

Eka Ginanjar, Idrus Alwi, Aida Lydia, Suzanna Immanuel, Muhammad Yamin, Taufik Indrajaya, Kuntjoro Harimurti

Abstract


Background: chronic kidney disease (CKD) increases the severity and risk of mortality in acute coronary syndrome (ACS) patients. The role of β2-M as a filtration and inflammation marker and FGF23 as a CKD-MBD process marker might be significant in the pathophysiology in ACS with CKD patients. This study aims to determine the association of β2-M and FGF23 with major adverse cardiac event (MACE) in ACS patients with CKD. Methods: we used cross sectional and retrospective cohort analysis for MACE. We collected ACS patients with CKD consecutively from January until October 2018 at Dr. Cipto Mangunkusumo General Hospital. Data were analyzed using logistic regression and Cox’s Proportional Hazard Regression. Results: a total of 117 patients were selected according to the study criteria. In bivariate analysis, β2-M, FGF23, and stage of CKD had significant association with MACE (p = 0.014, p = 0.026, p = 0.014, respectively). In multivariate analysis, β2-M - but not FGF 23- was significantly associated with MACE (adjusted HR 2.16; CI95% 1.15–4.05; p = 0.017). Conclusion: β2-M was significantly associated with MACE, while FGF23 was not so. This finding supports the role of inflammation in cardiovascular outcomes in ACS with CKD patient through acute on chronic effect.


Keywords


Beta2-Microglobulin; Fibrioblast Growth Factor 23; Acute Coronary Syndrome; Major Adverse Cardiac Event

References


Muhadi, Antono D, Alwi I. Karakteristik sindrom koroner akut dengan edema paru kardiogenik di ICCU RS Cipto Mangunkusumo dan faktor-faktor yang berhubungan. Tesis. Jakarta: Universitas Indonesia; 2009.

Bae EH, Lim SY, Cho KH, et al. GFR and cardiovascular outcomes after acute myocardial infarction: Results from the Korea acute myocardial infarction registry. Am J Kidney Dis. 2012;59(6):795–802.

Jimbo R, Shimosawa T. Cardiovascular risk factors and chronic kidney disease—FGF23: A key molecule in the cardiovascular disease. Int J Hypertens. 2014;2014;1-9.

Amighi J, Hoke M, Mlekusch W, et al. Beta2- microglobulin and the risk for cardiovascular events in patients with asymptomatic carotid atherosclerosis. Stroke. 2011;42(7):1826–33.

Joosten MM, Pai JK, Bertoia ML, et al. β2‐microglobulin, cystatin C, and creatinine and risk of symptomatic peripheral artery disease. J Am Heart Assoc. 2014;3(4):e000803.

Rashid G, Korzets Z, Bernheim J. Advanced glycation end products stimulate tumor necrosis factor-alpha and interleukin-1 beta secretion by peritoneal macrophages in patients on continuous ambulatory peritoneal dialysis. Isr Med Assoc J. 2006;8(1):36-9.

Kawai K, Kawashima S, Miyazaki T, et al. Serum beta2-microglobulin concentration as a novel marker to distinguish levels of risk in acute heart failure patients. J Cardiol. 2010;55(1):99–107.

Liabeuf S, Lenglet A, Desjardins L, et al. Plasma beta-2 microglobulin is associated with cardiovascular disease in uremic patients. Kidney Int. 2012;82(12):1297–303.

Lima F, El-Husseini A, Monier-Faugere M-C, et al. FGF-23 serum levels and bone histomorphometric results in adult patients with chronic kidney disease on dialysis. Clin Nephrol. 2014;82(5):287-95.

Arnlov J, Carlsson AC, Sundström J, et al. Serum FGF23 and risk of cardiovascular events in relation to mineral metabolism and cardiovascular pathology. Clin J Am Soc Nephrol. 2013;8(5):781–6.

Head SJ, Farooq V, Serruys PW, Kappetein AP. The SYNTAX score and its clinical implications. Heart. 2014;100(2):169–77.

Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol [Internet]. 1983 Feb;51(3):606. Available from: https://doi.org/10.1016/s0002-9149(83)80105-2

Stenvinkel P, Carrero JJ, Axelsson J, et al. Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: How do new pieces fit into the uremic puzzle? Clin J Am Soc Nephrol. 2008;3(2):505–21.

Mosbah O, Hruska KA, Williams MJ, Sugatani T. Chronic kidney disease–Mineral and bone disorders. Chronic Ren Dis. 2020;2(2):551–69.

Chen ZW, Chen YH, Qian JY, Ma JY, Ge JB. Validation of a novel clinical prediction score for severe coronary artery diseases before elective coronary angiography. PLoS One. 2014;9(4):e94493.

Mandelzweig L, Battler A, Boyko V, et al. The second euro heart survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006;27(19):2285–93.

Zoccali C, Yilmaz MI, Mallamaci F. FGF23: Amature renal and cardiovascular risk factor? Blood Purif. 2013;36(1):52–7.

Alwi I. Infark Miokard Akut dengan Elevasi. In: Buku Ajar Ilmu Penyakit Dalam Edisi 6. Jakarta: Interna Publishing; 2014:1457-9.

Nitta K. Fibroblast growth factor 23 and cardiovascular disease in patients with chronic kidney disease. Ren Replace Ther. 2018;4(1):1–8.

Rosenberg, MA, Manning WJ. Diastolic dysfunction and risk of atrial fibrillation. Circulation [Internet]. 2012 Nov 6;126(19):2353–62. Available from: https://doi.org/10.1161/CIRCULATIONAHA.112.113233

Xie J, Wang Y, Freeman III ME, Barlogie B, Yi Q. β2-microglobulin as a negative regulator of the immune system: High concentrations of the protein inhibit in vitro generation of functional dendritic cells. Blood, J Am Soc Hematol. 2003;101(10):4005–12.

Qin Z, Liu X, Song M, et al. Fibroblast growth factor 23 as a predictor of cardiovascular and all-cause mortality in prospective studies. Atherosclerosis. 2017;261:1–11.

Gutierrez OM, Mannstadt M, Isakova T, et al. Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med. 2008;359(6):584–92.


Full Text: PDF

Refbacks

  • There are currently no refbacks.