Soluble CD14 Levels, Interleukin 6, and Mortality Among Prevalent Hemodialysis Patients

Background: CD14 is a pattern-recognition receptor that has a central immunomodulatory role in proinflammatory signaling in response to a variety of ligands, including endotoxin. CD14 protein is present in 2 forms: soluble (sCD14) and membrane bound. Here, we studied the implications of increased sCD14 levels in hemodialysis patients. We hypothesized that sCD14 level increase may link to cytokine activation and protein-energy wasting, predisposing to increased mortality risk. Study Design: Prospective observational study of prevalent hemodialysis patients. Setting & Participants: 211 prevalent hemodialysis patients, median age of 65 years, with 29 months of vintage dialysis time followed up for mortality for a median of 31 months. Predictors: Tertiles of baseline circulating sCD14 levels corresponding to less than 2.84, 2.85 to 3.62, and greater than 3.63 mu g/mL. Outcome: The major outcome of interest was all-cause mortality. Measurements: sCD14 and endotoxin, together with other markers of inflammation and protein-energy wasting. Results: Median sCD14 level was 3.2 mu g/mL (25th to 75th percentile, 2.7 to 3.9). sCD14 level correlated positively with C-reactive protein, interleukin 6, endotoxin, and pentraxin 3 levels and negatively with serum albumin level, muscle mass, and handgrip strength. Patients with increased sCD14 levels had lower body mass index and increased prevalence of muscle atrophy. Patients within the highest sCD14 terlile had a crude morality hazard ratio of 1.94 (95% confidence interval, 1.13 to 3.32) that persisted after adjustment for multiple confounders (hazard ratio, 3.11; 95% confidence interval, 1.49 to 6.46). In patients with persistent inflammation, the presence of a concurrent sCD14 level increase gradually increased mortality risk, but this effect was less than multiplicative and failed to show a statistical interaction. Limitations: Those inherent to an observational study. Conclusions: sCD14 level is associated with inflammation and protein-energy wasting in hemodialysis patients, It is a strong and independent predictor of mortality that warrants further assessment in the clinical setting regarding its usefulness as a complementary prognosticator to other general inflammatory markers. Am J Kidney Dis 54:1072-1080. (C) 2009 by the National Kidney Foundation, Inc.