RESEARCH PAPER
Neopterin in patients with chronic kidney disease and patients with coronary artery disease

Neopterin, a marker of stimulated cellular immune response, levels increase during many disorders. A number

of different features of neopterin prompted us to study its serum concentration in patients with all stages of chronic

kidney disease (CKD) and patients with coronary artery disease (CARD). To the best of our knowledge this

is the first study that evaluates and compares the serum neopterin concentration in those diseases taken together

as one study. One hundred and twenty five subjects, divided into five groups, were included in the study. The first

three groups consisted of patients with different stages of CKD. CARD patients without CKD and healthy volunteers

as controls were also studied. Serum neopterin concentration was measured by an enzyme-linked immunosorbent

assay (ELISA, BRAHMS, Hennigsdorf/Berlin, Germany) according to the manufacturers’ instructions.

We have found that patients with the most advanced stage of CKD had fifteen times higher serum neopterin than

patients from other studied groups. Interestingly, in the CKD1-2, CKD3-4 and CARD patients without CKD, serum

neopterin concentrations were similar to those obtained from healthy volunteers. Serum urea and serum ferritin

appeared to be significant independent predictors of serum neopterin concentration after adjustment for urea,

CA-IMT, peripheral systolic blood pressure, ferritin, hsCRP, HD vintage, BMI and eGFR, explaining 95.89% of

serum neopterin variations. In conclusion, it seems that despite the existence of many factors that may influence

serum neopterin, those derived from impaired renal function and immunological disturbances coming from

hemodialysis treatment are crucial. In this study, we observed that the more impaired the renal function, higher

is the increase in serum neopterin concentration.