Elevated levels of circulating cell-free DNA (CFD) in hemodialysis (HD) patients independently predicts an increased risk of death, new findings suggest.

CFD appears following cell damage and DNA release, and increases in HD patients, especially following dialysis. In a prospective study, David Tovbin, MD, and colleagues at Ben-Gurion University in Beer-Sheva, Israel, measured CFD levels in 31 chronic HD without acute disease before and after they dialyzed. To obtain the measurements, Dr. Tovbin’s group used a rapid, non-cumbersome, inexpensive fluorometric assay that they developed.

During 42 months of follow-up, 13 subjects (41.9%) died. The decedents were older than survivors (69.9 vs. 61.5 years), but the two groups did not differ significantly in duration of end-stage renal disease (ESRD), gender, albumin, hemoglobin, diabetes mellitus, and weight.

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Post-dialysis CFD levels were significantly lower in survivors (median 688 vs. 880 ng/mL). The sensitivity and specificity of CFD levels of 850 ng/mL to predict mortality at 42 months were 73% and 75%, respectively, the investigators reported online in Nephrology Dialysis Transplantation. A CFD value above 850 ng/mL was associated with a significant eightfold increased risk of all-cause mortality, after adjusting for age, ESRD duration, weight, and creatinine levels.