The Role of GDF-15 in Heart Failure Patients With Chronic Kidney Disease
Jazyk angličtina Země Anglie, Velká Británie Médium print-electronic
Typ dokumentu časopisecké články, práce podpořená grantem
PubMed
30935637
DOI
10.1016/j.cjca.2018.12.027
PII: S0828-282X(18)31389-8
Knihovny.cz E-zdroje
- MeSH
- antagonisté receptorů pro angiotenzin terapeutické užití MeSH
- biologické markery krev MeSH
- cholesterol krev MeSH
- chronická renální insuficience farmakoterapie epidemiologie MeSH
- hodnoty glomerulární filtrace MeSH
- inhibitory ACE terapeutické užití MeSH
- krevní tlak MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- natriuretický peptid typu B krev MeSH
- podpůrné srdeční systémy statistika a číselné údaje MeSH
- proporcionální rizikové modely MeSH
- růstový diferenciační faktor 15 krev MeSH
- sexuální faktory MeSH
- sodík krev MeSH
- systola MeSH
- systolické srdeční selhání krev mortalita chirurgie MeSH
- transplantace srdce statistika a číselné údaje MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- antagonisté receptorů pro angiotenzin MeSH
- biologické markery MeSH
- cholesterol MeSH
- GDF15 protein, human MeSH Prohlížeč
- inhibitory ACE MeSH
- natriuretický peptid typu B MeSH
- růstový diferenciační faktor 15 MeSH
- sodík 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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