Matrix Metalloproteinase 2 and Osteoprotegrin as New Markers of Increased Atherosclerotic Risk in Egyptian Patients with Chronic Kidney Disease.

The prevalence of chronic kidney disease (CKD) is rising continuously. Cardiovascular disease (CVD) is among the leading causes of death and premature mortality of patients with CKD. It has been suggested that the assessment of CKD-associated CVD risk factors together with conventional risk factors should be performed in order to improve the prediction of coronary heart disease risk. The reduction of these factors seems to be effective in lowering cardiovascular (CV) morbidity and mortality in patients with CKD. Measuring subclinical atherosclerosis in CKD may significantly improve CVD risk prediction. Additionally, novel early atherosclerosis biomarkers, as well as possible therapeutic targets, are greatly needed in CKD patients. Matrix Metalloproteinase 2 (MMP2) and osteoprotegerin (OPG) may fall into this category of both useful markers and targets in CKD disease. The aim of this study was to investigate MMP2 and OPG as markers of increased risk of atherosclerosis in CKD. The present study included 40 patients with CKD divided into two groups: 20 patients with stage 1-4 (group I) and 20 patients with end stage renal disease (ESRD) (group II). They were compared with 20 sex and age matched healthy individuals as a control group (group III). Levels of MMP2, OPG were measured by ELISA. Cardiac echocardiography was performed to assess structural integrity and function. There was highly significant increase in MMP2 and OPG levels in group II when compared with group I and group III (P=0.000 and P=0.000 respectively) and in group I when compared with group III (P=0.000). A highly significant difference was also found between the three groups as regard mitral and aortic calcification (P=0.000) and mitral, aortic and tricuspid regurge (P=0.000, 0.002 and 0.001 respectively). There was a positive correlation between OPG and MMP2 and significant relation between OPG and mitral and aortic calcification. In conclusion, MMP-2 and OPG may be involved in the pathogenesis of atherosclerosis in patients with CKD and could potentially be of use as biomarkers of subclinical atherosclerosis in these patients. The increase in mitral and aortic calcifications may suggest the reasons for increased CV risk in these patients.