Longer Telomere Length in Patients with Balkan Endemic Nephropathy Undergoing Chronic Hemodialysis Is Associated with Lower Cardiovascular Mortality

Key Points Longer telomeres are associated with less cardiovascular mortality in patients undergoing chronic hemodialysis. In patients with Balkan endemic nephropathy, telomere length was negatively associated with arterial stiffness and positively associated with survival. The association of Balkan endemic nephropathy with slower vascular aging and longer telomere length may partially explain this phenomenon. Background Balkan endemic nephropathy (BEN) is characterized with later onset and milder forms of hypertension and lower pulse wave velocity than other ESKD. Longer telomeres are associated with better cardiovascular (CV) prognosis. Therefore, we hypothesized that telomere length (TL) could be longer in patients with BEN compared with other patients with ESKD. Methods A total of 124 patients undergoing hemodialysis (68 BEN, 56 non-BEN) were enrolled and followed-up for 72 months. TL was measured in leukocytes by Southern blot at inclusion. Results Age- and sex-adjusted TL was significantly longer in the BEN group ( P < 0.001). TL was negatively associated with carotid-femoral pulse wave velocity in patients with BEN. Patients with BEN had significantly lower CV mortality than patients with non-BEN ESKD ( P < 0.001). In the BEN group, shorter TL (1 kb change) was the only determinant of shorter survival (hazard ratio, 0.11). Using the TL threshold defined by receiver operating characteristic analysis (TL <6.21 kb), we showed in both groups significantly higher CV mortality in the presence of short telomeres (log-rank [Mantel- P < 0.001]). Conclusions Longer telomeres are associated with less CV mortality in patients undergoing chronic hemodialysis. Patients with BEN had longer TL and longer survival than that of patients with other ESKD. In patients with BEN, TL was negatively associated with arterial stiffness and positively associated with survival. This study confirmed our hypothesis that BEN is associated with slower vascular aging and that longer TL may partially explain this phenomenon.