Department of Medicine, University of Washington, Seattle, WA.
Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA.
Am J Kidney Dis. 2018 Oct;72(4):519-528. doi: 10.1053/j.ajkd.2018.03.025. Epub 2018 Jun 14.
RATIONALE & OBJECTIVE: Inflammation, cardiac remodeling, and fibrosis may explain in part the excess risk for cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Growth differentiation factor 15 (GDF-15), galectin 3 (Gal-3), and soluble ST2 (sST2) are possible biomarkers of these pathways in patients with CKD. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: Individuals with CKD enrolled in either of 2 multicenter CKD cohort studies: the Seattle Kidney Study or C-PROBE (Clinical Phenotyping and Resource Biobank Study). EXPOSURES: Circulating GDF-15, Gal-3, and sST2 measured at baseline. OUTCOMES: Primary outcome was all-cause mortality. Secondary outcomes included hospitalization for physician-adjudicated heart failure and the atherosclerotic CVD events of myocardial infarction and cerebrovascular accident. ANALYTIC APPROACH: Cox proportional hazards models used to test the association of each biomarker with each outcome, adjusting for demographics, CVD risk factors, and kidney function. RESULTS: Among 883 participants, mean estimated glomerular filtration rate was 49±19mL/min/1.73m. Higher GDF-15 (adjusted HR [aHR] per 1-SD higher, 1.87; 95% CI, 1.53-2.29), Gal-3 (aHR per 1-SD higher, 1.51; 95% CI, 1.36-1.78), and sST2 (aHR per 1-SD higher, 1.36; 95% CI, 1.17-1.58) concentrations were significantly associated with mortality. Only GDF-15 level was also associated with heart failure events (HR per 1-SD higher, 1.56; 95% CI, 1.12-2.16). There were no detectable associations between GDF-15, Gal-3, or sST2 concentrations and atherosclerotic CVD events. LIMITATIONS: Event rates for heart failure and atherosclerotic CVD were low. CONCLUSIONS: Adults with CKD and higher circulating GDF-15, Gal-3, and sST2 concentrations experienced greater mortality. Elevated GDF-15 concentration was also associated with an increased rate of heart failure. Further work is needed to elucidate the mechanisms linking these circulating biomarkers with CVD in patients with CKD.
背景与目的:炎症、心脏重构和纤维化可能部分解释了慢性肾脏病(CKD)患者发生心血管疾病(CVD)的风险增加。生长分化因子 15(GDF-15)、半乳糖凝集素 3(Gal-3)和可溶性 ST2(sST2)是 CKD 患者这些通路的潜在生物标志物。
研究设计:观察性队列研究。
研究场所和参与者:纳入了两项多中心 CKD 队列研究之一的西雅图肾脏病研究或 C-PROBE(临床表型和资源生物库研究)的 CKD 患者。
暴露因素:基线时测量循环中的 GDF-15、Gal-3 和 sST2。
主要转归:全因死亡率。次要结局包括因医生判断的心力衰竭而住院和心肌梗死及脑血管意外等动脉粥样硬化性 CVD 事件。
分析方法:使用 Cox 比例风险模型来检验每种生物标志物与每种结局的关联,调整了人口统计学、CVD 危险因素和肾功能。
结果:在 883 名参与者中,平均估算肾小球滤过率为 49±19mL/min/1.73m2。较高的 GDF-15(每增加 1-SD,调整后 HR [aHR],1.87;95%CI,1.53-2.29)、Gal-3(每增加 1-SD,aHR,1.51;95%CI,1.36-1.78)和 sST2(每增加 1-SD,aHR,1.36;95%CI,1.17-1.58)浓度与死亡率显著相关。只有 GDF-15 水平也与心力衰竭事件相关(每增加 1-SD,HR,1.56;95%CI,1.12-2.16)。在 GDF-15、Gal-3 或 sST2 浓度与动脉粥样硬化性 CVD 事件之间未检测到任何关联。
局限性:心力衰竭和动脉粥样硬化性 CVD 的事件发生率较低。
结论:患有 CKD 且循环中 GDF-15、Gal-3 和 sST2 浓度较高的成年人死亡率更高。升高的 GDF-15 浓度也与心力衰竭发生率增加相关。需要进一步的工作来阐明这些循环生物标志物与 CKD 患者 CVD 之间的关联机制。
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