Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Department of Vascular Medicine, Osaka City University Graduate School of Medicine.
J Atheroscler Thromb. 2022 Aug 1;29(8):1153-1165. doi: 10.5551/jat.62992. Epub 2021 Sep 11.
Patients with chronic kidney disease (CKD) have elevated risk of death from cardiovascular disease (CVD). A low serum insulin-like growth factor 1 (IGF-1) level is known to predict higher risk for all-cause mortality in incident dialysis patients, although it is unknown whether IGF-1 predicts cardiovascular outcomes.
This was a prospective cohort study of maintenance hemodialysis patients followed up for 5 years. Serum IGF-1 levels were measured at baseline, and patients were divided into IGF-1 tertiles. The key outcomes were all-cause mortality, a composite of new CVD, and death after new CVD events. Additional outcomes were hospitalization for infection and subsequent death. Association was analyzed using Cox proportional hazards models.
In the 516 patients that were analyzed, we identified 106 all-cause deaths, 190 new CVD events, and 61 subsequent deaths. In addition, there were 169 hospitalizations for infection and 47 subsequent deaths. The risk of all-cause death was the highest in the lowest IGF-1 tertile, and this association remained significant in multivariable-adjusted models. Regarding CVD outcomes, IGF-1 was not associated with new CVD events but significantly associated with subsequent death in adjusted models. Similarly, IGF-1 was not an independent predictor of hospitalization for infection, but it predicted subsequent death.
A low IGF-1 level was not a significant predictor of new CVD events but an independent predictor of subsequent death in hemodialysis patients. Since similar associations with infection outcomes were observed, IGF-1 may be a biomarker of fragility or frailty in this population.
患有慢性肾脏病（CKD）的患者死于心血管疾病（CVD）的风险较高。已知血清胰岛素样生长因子 1（IGF-1）水平较低可预测新透析患者全因死亡率的风险较高，尽管尚不清楚 IGF-1 是否可预测心血管结局。
这是一项对维持性血液透析患者进行的前瞻性队列研究，随访时间为 5 年。在基线时测量血清 IGF-1 水平，并将患者分为 IGF-1 三分位组。主要结局为全因死亡率、新发 CVD 的复合结局以及新发 CVD 后死亡。其他结局为感染住院和随后的死亡。使用 Cox 比例风险模型分析相关性。
在分析的 516 名患者中，我们发现 106 例全因死亡、190 例新发 CVD 事件和 61 例随后死亡。此外，有 169 例因感染住院和 47 例随后死亡。IGF-1 最低三分位组的全因死亡风险最高，多变量调整模型仍显示这种相关性具有统计学意义。关于 CVD 结局，IGF-1 与新发 CVD 事件无关，但在调整模型中与随后的死亡显著相关。同样，IGF-1 不是感染住院的独立预测因子，但可预测随后的死亡。
低 IGF-1 水平不是新 CVD 事件的显著预测因子，但在血液透析患者中是随后死亡的独立预测因子。由于观察到与感染结局的类似关联，IGF-1 可能是该人群脆弱性或衰弱的生物标志物。
