Plasma Endocan Level as a Predictor of Cardiovascular Composite Outcomes in Patients With End-Stage Renal Disease.

Background: Endocan, a proteoglycan which is a potential biomarker of endothelial dysfunction, has been shown to be associated with increased cardiovascular risk. We investigated plasma levels of endocan in patients with end-stage renal disease (ESRD) on hemodialysis to predict the risk of cardiovascular diseases. Methods: A total of 400 adult patients with ESRD undergoing hemodialysis were prospectively enrolled in 4 tertiary hospitals of South Korea from June 2016 to May 2018. They were observed for development of the cardiovascular composite outcomes. We compared clinical characteristics and the plasma levels of endocan between 47 patients with cardiovascular composite outcomes and 353 control patients without cardiovascular composite outcomes, and developed the predictive markers of cardiovascular diseases using Cox proportional-hazard analysis. Results: Previous histories of diabetes, acute coronary syndrome, arrhythmia and congestive heart failure were higher in ESRD patients with the cardiovascular composite outcomes than control patients. Patients with cardiovascular composite outcomes showed lower levels of hemoglobin, albumin, and high-density lipoproteins compared with control patients. Higher level of plasma endocan and white blood cells were associated with patients with cardiovascular composite outcomes. Cox proportional-hazard analysis showed that previous histories of diabetes and plasma level endocan were significantly associated with cardiovascular composite outcomes: hazard ratios were 2.1 (95% confidential interval (CI), 1.1 to 4.3) ( p = 0.03) for diabetes and 15.4 (95% CI, 3.2 to 75.2) ( p = 0.001) for endocan (log pg/mL). The patients with level of endocan of 2.96 log pg per mL or more showed significantly higher cumulative incidence of the cardiovascular composite outcomes in Kaplan-Meier curve ( p = 0.03). Conclusions: Plasma Endocan level can a useful biomarker for prediction of cardiovascular diseases in patients with ESRD on hemodialysis.