Retinoic acid associates with mortality of patients on long-term hemodialysis

Abstract

Background Retinol concentrations in serum are significantly higher in patients on hemodialysis (HD) compared to healthy controls. Its lower concentrations have been reported to be an independent predictor of mortality. ATRA – all-trans retinoic acid – is an important compound related to retinol. The objective was to determine ATRA concentrations in serum and to find their association with the prognosis of patients on long-term HD.Methods ATRA was determined by high-performance liquid chromatography in a group of 247 HD patients (follow-up five years) and 54 healthy controls.Results Although serum retinol concentrations were higher in the studied cohort of HD patients, ATRA was lower – median 1.13 (interquartile range 0.90–1.60) ng/mL in HD patients versus 1.42 (1.08–1.63) ng/mL in healthy controls, p = 0.02. Lower ATRA was significantly related to overall mortality of HD patients (HR (95%CI) 0.63 (0.47–0.85) per interquartile range, p = 0.003). The best prognosis was observed in patients with concentrations of both ATRA and retinol above the median (p = 0.003).Conclusions We detected decreased retinoic acid levels in HD patients compared to healthy controls. Lower concentrations of ATRA represent a significant predictor of mortality and provide additional information to retinol.

Keywords

• ATRA
• cardiovascular
• hemodialysis
• mortality
• outcome
• retinol