意义未定的克隆性造血与慢性肾脏病心血管风险增加相关

Background: Patients with chronic kidney disease (CKD) exhibit an extremely high prevalence of coronary artery disease. Clonal hematopoiesis of indeterminate potential (CHIP) and CKD share pathological features such as aging, chronic inflammation, and accelerated atherosclerosis. Their coexistence can synergistically exacerbate vascular damage and increase coronary risk. However, the association between CHIP and specific coronary lesions in CKD populations has not been reported, and its relationship with cardiovascular events remains controversial. Methods: A total of 151 patients with CKD who underwent coronary angiography were prospectively included. To evaluate the status of CHIP, we utilized high-depth targeted sequencing, and measured serum inflammatory factor levels. Furthermore, we systematically followed up these patients to document the occurrence of adverse clinical events. Results: CHIP was identified in 65 (43.0%) CKD patients, with the carrier rate steadily rising with age. The CHIP subjects had higher rates of left circumflex stenosis, three-vessel disease, and Gensini scores than non-CHIP patients (all P < .05). After adjusting for relevant clinical risk factors, the presence of CHIP continued to show an independent association with three-vessel disease [odds ratio 2.26, 95% confidence interval (CI) 1.07-4.75; P = .032]. The survival analysis indicated that CHIP, along with non-DNMT3A mutations and a larger clone size (variant allele frequency ≥0.10), correlated with the primary composite endpoint (P < .01). Even after controlling for various clinical variables, the CHIP status still demonstrated an independent association with the primary composite endpoint (hazard ratio 2.02, 95% CI 1.11-3.67; P = .022). Conclusions: CHIP was associated with the severity of coronary lesions and unfavorable clinical outcomes in patients with CKD.