Longer telomere length in balkan endemic nephropathy patients undergoing chronic hemodialysis is associated with lower cardiovascular mortality

Objective: Balkan endemic nephropathy (BEN) is characterized with later onset, milder forms of hypertension and lower pulse wave velocity (PWV) than other end-stage kidney disease (ESKD). We hypothesized that telomere length (TL) would be longer in BEN patients and associated with lower PWV and less cardiovascular (CV) mortality. Design and method: 124 patients undergoing hemodialysis (HD) (68 BEN, 56 non-BEN; 48.4% men; 65±14 years) were enrolled and followed-up for 72 months. Blood pressure and PWV were determined before mid-week dialysis. TL was measured in leukocytes by Southern blot. Results: Age and sex-adjusted TL was significantly longer in the BEN group (7.19 kb vs 6.79 kb; p<0.001). TL was associated in the BEN group with PWV, and in the non-BEN group with age. BEN patients presented significantly lower CV mortality than non-BEN patients (p<0.001). In the BEN group shorter TL was the only determinant of shorter survival (HR 0.11 [95% CI 0.03, 0.35]). To analyze the diagnostic value of TL for CV mortality we used ROC analysis that revealed TL < 6.21 kb to be useful for prediction of CV mortality in patients undergoing chronic HD. Conclusions: Shorter TL is associated with CV mortality in patients undergoing chronic HD. BEN patients had longer TL and longer survival than other ESKD patients. In BEN patients, TL was negatively associated with PWV. This study confirmed our hypothesis that BEN is associated with slower vascular aging and that longer TL may partially explain this phenomenon.