Prognostic role of circulating neutrophil extracellular traps levels for long-term mortality in new end-stage renal disease patients

Dysregulation of innate immunity has been proposed as an important contributing factor for advanced atherosclerosis and resultant high mortality in hemodialysis (HD) patients. To evaluate the long-term prognostic role of in vivo neutrophil extracellular traps (NETs), we measured circulating serum nucleosome, myeloperoxidase (MPO), and DNase I levels in 281 incident HD patients. Circulating nucleosome level was significantly higher in HD patients compared to controls, and it was closely associated with MPO levels, suggesting increased in vivo NETs in uremia. Patients in the nucleosome Q4 group had significantly increased all-cause and adverse CV mortality compared to those in the Q1–3 group even after adjusting traditional risk factors Also, serum DNase I level was significantly higher in HD patients than controls (2.76 ± 1.02 ng/ml and 1.93 ± 0.85 ng/ml), but it had no correlation with NETs. Interestingly, it serves an additive biomarker for predicting poor CV outcomes. The two novel biomarkers might provide an importance independent prognostic significance in incident HD patients. •In ESRD, the level of circulating nucleosome and MPO, markers of in vivo NET, is significantly higher than controls.•Higher circulating nucleosome was independently associated with increased risks of all-cause and cardiovascular mortality.•Serum DNase I level was not correlated with in vivo NETs amount.•However, it was an important additive biomarker for predicting adverse CV outcomes independent to nucleosome levels.