Clinical Significance of miR-21-5p in Predicting Occurrence and Progression of Uremic Vascular Calcification in Patients with End-Stage Renal Disease

Abstract

Purpose Vascular calcification (VC) is a common complication of end-stage renal disease (ESRD). This study aimed to examine changes in the expression of miR-21-5p in ESRD patients with VC and to explore its clinical value in predicting the occurrence and progression of uremic VC. Materials and Methods 120 ESRD patients were divided into patients without VC group (n=38) and patients with VC group (n=82). All patients were followed up for 2 years to evaluate VC progression. qRT-PCR was used to detect serum miR-21-5p levels. Receiver operating characteristic curves were constructed to assess diagnostic value. Kaplan-Meier and log-rank methods were utilized to calculate associations between VC progression and risk factors. Results Serum miR-21-5p levels were significantly higher in ESRD patients with VC than in those without VC and increased progressively with increasing disease severity. Serum miR-21-5p levels were able to distinguish patients with VC from those without VC, with an area under the curve value of 0.883, a sensitivity of 81.7%, and a specificity of 84.2%. After 2 years of follow-up, miR-21-5p expression had increased in patients with worse VC severity, compared with those with stable VC severity. Patients with high miR-21-5p levels were more likely to develop more severe VC, indicating an association between miR-21-5p and VC progression (log-rank p =0.002). Multivariable Cox regression analysis suggested that serum miR-21-5p is an independent predictive factor of VC progression in ESRD patients (hazard ratio=2.064, 95% confidence interval=1.225–3.478, p =0.006). Conclusion miR-21-5p is overexpressed in the serum of ESRD patients with VC. Our results suggest that overexpression of miR-21-5p is closely associated with VC progression.

Aplicaciones clínicas de miR-21: revisión de la literatura

“…miR-21 está elevado en modelos de podocitos lesionados y en casos de enfermedad renal crónica en proporción inversa a la tasa de filtración glomerular estimada, lo cual alienta a proponerlo como marcador pronóstico (31). En pacientes con enfermedad renal terminal, miR-21 ha mostrado ser un factor predictivo independiente de calcificación vascular, la cual juega un papel importante en la mortalidad de pacientes con esta condición (32).…”

Vascular calcification in CKD: New insights into its mechanisms

“…Similarly, serum miR‐21‐5p levels were significantly higher in ESRD patients with VC in comparison to those without, and increased progressively as the severity of the condition worsened. Multivariable Cox regression analysis suggested that serum miR‐21‐5p is an independent predictive factor of VC progression in ESRD patients (Wu et al, 2022). Taken together, serum miRNAs can serve as a promising biomarker to predict the presence and, more importantly, progression of uremia‐associated VC.…”