Correlation of plasma expression of cartilage oligomeric matrix protein with arteriovenous fistula failure and prognosis in hemodialysis patients with end-stage renal disease

Objective To detect the expression of cartilage oligomeric matrix protein (COMP) in hemodialysis patients with end-stage renal disease (ESRD) and explore the correlation between COMP and failure and prognosis of arteriovenous fistula (AVF).Methods From February 2015 to February 2017, a total of 150 ESRD patients undergoing AVF operation at hemodialysis center were selected as research subjects.Based upon the failure or not of AVF, they were divided into two groups of patency (n=98) and failure (n=52).And according to the calcification status of radial artery stumps, they were divided into two groups of calcification (n=66) and non-calcification (n=84).Spearman's method was employed for analyzing the relationship between vascular calcification and AVF.Clinical data of the subjects were collected, the serum levels of urea nitrogen (BUN), creatinine (Scr) and uric acid (UA) were detected by an automatic biochemical analyzer.After 2-year follow-ups, they were divided into two groups of good prognosis (n=92) and poor prognosis (n=58).Plasma level of COMP was measured by enzyme linked immunosorbent assay (ELISA).Receiver operating characteristic curve (ROC) was utilized for determining the predictive value of plasma COMP level for vascular calcification and AVF dysfunction.Kaplan-Meier method was employed for elucidating the relationship between plasma COMP level and prognosis.And COX regression analysis was utilized for analyzing the risk factors affecting the prognosis of ESRD patients.Results The plasma level of COMP was lower in patency group than that in failure group (P<0.05) and plasma COMP level was lower in non-vascular calcification group than that in vascular calcification group (P<0.05).A positive correlation existed between AVF failure and vascular calcification (r=0.526, P<0.05).ROC analysis indicated that area under the curve (AUC) of plasma COMP for predicting vascular calcification in ESRD patients was 0.827(95%CI:0.748-0.906) and AUC for predicting AVF failure was 0.865(95%CI:0.795-0.936) in ESRD patients.Kaplan-Meier analysis showed that the 3-year cumulative survival rate was 69.33%(104/150).The 3-year cumulative survival rate of patients with a high expression of COMP was lower than that of those a low expression of COMP (59.46%vs 78.95%, χ²=8.525, P<0.05).Multivariate Cox analysis indicated that a high COMP level was a risk factor for poor prognosis in ESRD patients (HR=3.559, P<0.05).Conclusion Higherplasma level of COMP has predictive value for vascular calcification and AVF dysfunction in ESRD hemodialysis patients.As a risk factor for poor prognosis, it may be used as a prognostic marker of ESRD patients.