The Role of GDF-15 in Heart Failure Patients With Chronic Kidney Disease
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
30935637
DOI
10.1016/j.cjca.2018.12.027
PII: S0828-282X(18)31389-8
Knihovny.cz E-resources
- MeSH
- Angiotensin Receptor Antagonists therapeutic use MeSH
- Biomarkers blood MeSH
- Cholesterol blood MeSH
- Renal Insufficiency, Chronic drug therapy epidemiology MeSH
- Glomerular Filtration Rate MeSH
- Angiotensin-Converting Enzyme Inhibitors therapeutic use MeSH
- Blood Pressure MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Natriuretic Peptide, Brain blood MeSH
- Heart-Assist Devices statistics & numerical data MeSH
- Proportional Hazards Models MeSH
- Growth Differentiation Factor 15 blood MeSH
- Sex Factors MeSH
- Sodium blood MeSH
- Systole MeSH
- Heart Failure, Systolic blood mortality surgery MeSH
- Heart Transplantation statistics & numerical data MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Angiotensin Receptor Antagonists MeSH
- Biomarkers MeSH
- Cholesterol MeSH
- GDF15 protein, human MeSH Browser
- Angiotensin-Converting Enzyme Inhibitors MeSH
- Natriuretic Peptide, Brain MeSH
- Growth Differentiation Factor 15 MeSH
- Sodium MeSH
BACKGROUND: Growth differentiation factor-15 (GDF-15) is a stress-inducible cytokine and member of the transforming growth factor-β cytokine superfamily that refines prognostic assessment in subgroups of patients with heart failure (HF). We evaluated its role in HF patients with chronic kidney disease (CKD, estimated glomerular filtration rate <60 mL/min/1.73 m2). METHODS: A total of 358 patients with stable systolic HF were followed for a median of 1121 (interquartile range, 379-2600) days. Comprehensive evaluation including B-type natriuretic peptide (BNP) and GDF-15 testing was performed at study entry; the analysis was stratified according to kidney function. RESULTS: Patients with CKD (33.8%) were older, had more often diabetes, and were less often treated with angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB). GDF-15 was associated with estimated glomerular filtration rate, whereas BNP was associated with left ventricular-end diastolic diameter and ejection fraction (P < 0.01). During follow-up, 244 patients (68.2%) experienced an adverse outcome (death, urgent transplantation, implantation of mechanical circulatory support). In patients with HF and CKD, the Cox proportional hazard model identified BNP, GDF-15, sex, systolic blood pressure, sodium, total cholesterol, and ACEi/ARB treatment as significant variables associated with an adverse outcome (P < 0.05). In multivariable analysis, BNP was replaced by GDF-15. Net reclassification improvement confirmed prognostic superiority of the model encompassing GDF-15 (GDF-15, sodium, total cholesterol, ACEi/ARB treatment) compared with the model without GDF-15 (BNP, sex, sodium, ACEi/ARB treatment), net reclassification improvement 0.62, P = 0.005. In contrast, in patients with HF and normal kidney function, BNP remained superior to GDF-15 in a multivariable model. CONCLUSIONS: In patients with systolic HF and CKD, GDF-15 is more strongly associated with adverse outcomes than the conventionally used BNP.
Department of Cardiology Institute for Clinical and Experimental Medicine IKEM Prague Czech Republic
Department of Pathology Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA
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