Associations between Circulating Endothelial Progenitor Cells and Renal Function Open Access

Abstract

Objective: Decreased number and function of circulating endothelial progenitor cells (EPCs) have been reported in patients with chronic kidney disease (CKD). However, there is little information about the associations between circulating EPC levels and renal function as measured by Glomerular Filtration Rate (GFR) in patients with some type of coronary heart disease (CHD).Wepropose to obtain a summary measure of multiple circulating EPC types based on principal component analysis, and to investigate the associations between EPCs and GFR after adjusting for conventional risk factors.

Methods and Results: A total of 2,145 adult patients were enrolled prior to undergoing elective or emergent cardiac catheterization. Measurement of EPC counts by flow cytometry was based on the single or combination expression of surface markers on CD45^med and CD34 cells. Kidney function was measured by GFR using the Cockcroft-Gault formula that adjusts for body weight and body mass index. The associations between circulating EPCs and GFR were studied using principal component scores in multiple linear regression analyses. Statistically significant associations between GFR and circulating EPCs were observed in both unadjusted and adjusted analyses, indicating improvement in the number of EPCs especially those with certain VEGF cell types contribute to an increase in GFR levels.

Conclusions: Age, race, hypertension and diabetes are significant risk factors for CKD. EPCs are shown to be significantly associated with the GFR levels in the patients with CKD after adjusting for conventional risk factors. EPCs might be considered to be a potential therapeutic target for CKD, although more investigations still need to be implemented.

Table of Contents

1. Introduction. 1

1.1 Chronic Kidney Disease (CKD). 1

1.2 Glomerular Filtration Rate (GFR). 2

1.3 Current Treatment and Prevention Strategies for CKD. 2

1.4 Endothelial Progenitor Cells. 3

1.5 Study Goals. 5

1.6 Significance. 5

2. Methods. 6

2.1 Study Population. 6

2.2 Measurement of Kidney Function. 7

2.3 Circulating EPC Counts. 9

2.4 Statistical Analysis. 9

3. Results. 13

3.1 Patient Characteristics. 13

3.2 Principal Component Analysis (PCA). 14

3.3 Associations between Circulating EPCs and GFR. 14

3.4 Validation Analysis.16

4. Discussion. 17

4.1 Results. 17

4.2 Limitations. 18

4.3 Future Research. 19

4.4 Conclusions. 19

References. 28

Supplementary Material. 30

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics and Bioinformatics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Biology, Biostatistics Health Sciences, Public Health
Keyword	Endothelial Progenitor Cell Chronic Kidney Disease Principal Component Analysis Multiple Linear Regression
Committee Chair / Thesis Advisor	Long, Qi, Emory University Ko, Yi-An , Emory University
Committee Members	Kutner, Michael, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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