Abstract: Objective  To measure serum levels of secreted frizzled-related protein 5 (SFRP5) and histone deacetylase 4 (HDAC4) in maintenance hemodialysis (MHD) patients, and to investigate their relationship with major adverse cardiovascular events (MACE).  Methods  From September 2021 to September 2023, 167 MHD patients admitted to our hospital were enrolled. According to the occurrence of MACE during follow-up, they were divided into a MACE group (n=57) and a non-MACE group (n=110). ELISA method was used to measure serum SFRP5 and HDAC4. The influencing factors of MACE in MHD patients were analyzed. To evaluate the predictive value of serum SFRP5 and HDAC4 levels for MACE in MHD patients  Results  In the MACE group, dialysis duration (47.65±10.25) months, low-density lipoprotein cholesterol (3.11±0.35) mmol/L, parathyroid hormone (321.89±47.88) ng/L, systolic blood pressure (145.26±15.28) mmHg, and diastolic blood pressure (95.21±11.27) mmHg were all significantly higher than those in the non-MACE group (33.49±6.52) months, (2.85±0.33) mmol/L, (298.54±49.53)ng/L, (122.08±13.15) mmHg, (81.25±9.03) mmHg, respectively. Conversely, residual kidney glomerular filtration rate (5.49±1.36 ml/min/1.73 m2), residual kidney creatinine clearance rate (25.72±3.98)L/week, urea clearance index (0.54±0.13), and hemoglobin (108.32±12.29) g/L in the MACE group were significantly lower than those in the non-MACE group (6.43±1.85)mL/min/1.73 m², (28.36±4.57)L/week, 0.65±0.18, and (116.07±14.75)g/L, respectively; all t-values from 3.389 to 10.868, P＜0.001). Serum levels of SFRP5 (32.68±7.45)μg/L and HDAC4 (29.56±4.85) pg/mL in the MACE group were significantly lower than those in the non-MACE group (42.95 ±8.16)μg/L and (38.92±6.48)pg/mL, respectively; t=7.939, 7.547, P＜0.001]. Multivariate analysis identified the following as independent factors influencing MACE (all P＜0.05): dialysis duration (OR=1.723, 95% CI:1.047～2.835), low-density lipoprotein cholesterol (OR=1.835, 95%CI: 1.151～2.926), parathyroid hormone (OR=2.175, 95%CI: 1.103～4.281), residual kidney GFR (OR=0.523, 95%CI: 0.317～0.864), residual kidney Ccr (OR=0.512, 95%CI: 0.277～0.948), urea clearance index (OR=0.379, 95%CI: 0.166～0.865), systolic blood pressure (OR=1.946, 95%CI: 1.035～3.658), diastolic blood pressure (OR=2.135, 95%CI: 1.079～4.223), hemoglobin (OR=0.297, 95%CI: 0.107～0.821), serum SFRP5 (OR=0.479, 95% CI: 0.277～0.828), and HDAC4 (OR=0.435, 95%CI: 0.238～0.796). The area under the curve (AUC) for the combination of serum SFRP5 and HDAC4 in predicting MACE was 0.914, which was superior to the predictive value of either marker alone (Z combined vs. SFRP5 alone = 3.043, P=0.002; Z combined vs. HDAC4 alone = 2.770, P=0.006).  Conclusion  Serum levels of SFRP5 and HDAC4 in MHD patients are both decreased. The combined detection has a higher predictive value for the occurrence of MACE in MHD patients.

Key words: Secreted frizzled related protein 5, Histone deacetylase 4, Maintenance hemodialysis; ,  , Major adverse cardiovascular events