Association between Plasma Levels of Growth Differentiation Factor-15 and Renal Function in the Elderly: Korean Frailty and Aging Cohort Study
Association between Plasma Levels of Growth Differentiation Factor-15 and Renal Function in the Elderly: Korean Frailty and Aging Cohort Study
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DOI：
10.1159/000498959
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发表时间：
2019-01-01
影响因子：
2.8
通讯作者：
Jeong, Kyung Hwan
中科院分区：
文献类型：
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作者：
Kim, Jin Sug;Kim, Sunyoung;Jeong, Kyung Hwan
背景/目标：生长分化因子-15（GDF-15）表达已被报道响应于组织损伤而增加，并且最近已成为各种疾病的有用生物标志物。尽管新出现的证据支持GDF-15在肾损害中的临床病理学价值，但很少有研究分析老年人中的GDF-15。因此，我们进行了一项横断面研究，以调查血浆GDF-15与肾功能和慢性肾脏疾病（CKD）的社区居住的老年人的存在。材质：本研究基于韩国虚弱和老龄化队列研究（KFACS）的基线数据，这是一项始于2016年的全国性队列研究。在第一年评估的1，559名参与者中，有443名具有可用的血浆GDF-15数据的参与者入组本研究。我们研究了血浆GDF-15水平与临床和生化参数的相关性。研究人群根据肾功能分为两组（CKD组和非CKD组），以研究GDF-15是否可以确定老年人是否存在肾功能不全。采用酶联免疫吸附法（ELISA）测定血浆GDF-15水平。结果如下：在简单回归分析中，血浆GDF-15水平与估计的肾小球滤过率（eGFR; r =-0.383，p < 0.001）呈负相关。在多元线性回归分析中，GDF-15水平仍然与eGFR显著相关，即使在调整其他参数后（r =-0.259，p < 0.001）。CKD老年患者的血浆GDF-15水平显著高于非CKD老年患者（分别为2，364.025 +/-1，052.23 ng/L和1，451.23 +/- 835.79 ng/L; p < 0.001）。通过受试者工作特征曲线确定，检测CKD存在的血浆GDF-15的最佳截止值为1，699.4 ng/L（76.5%灵敏度和76.0%特异性）。曲线下面积为0.793 +/- 0.033（95% CI 0.729-0.857，p < 0.001）。结论：血浆GDF-15水平与eGFR呈负相关，且在老年CKD患者中显著升高。我们的研究结果表明，血浆GDF-15可能是一个有用的指标，鉴别老年人肾功能损害。需要进一步进行持续时间较长的大型前瞻性结局研究。
Background/Aims: Growth differentiation factor-15 (GDF-15) expression has been reported to increase in response to tissue damage and has recently emerged as a useful biomarker for various diseases. Although emerging evidence supports the clinicopathological value of GDF-15 in renal impairment, few studies have analyzed it in the elderly. Thus, we conducted a cross-sectional study to investigate the association of plasma GDF-15 with renal function and the presence of chronic kidney disease (CKD) in community-dwelling elderly. Materials: The present study was based on the baseline data of the Korean Frailty and Aging Cohort Study (KFACS), a nationwide cohort study that began in 2016. Of the 1,559 participants assessed in the first year, 443 with available plasma GDF-15 data were enrolled in this study. We investigated the association of plasma GDF-15 levels with clinical and biochemical parameters. The study population was divided into two groups according to renal function (CKD and non-CKD groups) to investigate whether GDF-15 can determine the presence of renal dysfunction in the elderly. Plasma GDF-15 was measured by enzyme-linked immunosorbent assay (ELISA) kit. Results: In a simple regression analysis, the levels of plasma GDF-15 were negatively correlated with estimated glomerular filtration rate (eGFR; r = -0.383, p < 0.001). In multiple linear regression analysis, GDF-15 levels were still significantly correlated with eGFR, even after adjusting for other parameters (r = -0.259, p < 0.001). Plasma GDF-15 levels were significantly higher in the elderly with CKD than in those without CKD (2,364.025 +/- 1,052.23 ng/L and 1,451.23 +/- 835.79 ng/L, respectively; p < 0.001). The optimal cut-off value of plasma GDF-15 for detecting the presence of CKD was 1,699.4 ng/L (76.5% sensitivity and 76.0% specificity), as determined by the receiver operating characteristic curve. The area under the curve was 0.793 +/- 0.033 (95% CI 0.729-0.857, p < 0.001). Conclusion: Plasma GDF-15 levels were negatively associated with eGFR and were significantly increased in the elderly with CKD. Our results suggested that plasma GDF-15 might be a useful marker for discriminating renal impairment in the elderly. Further large and prospective outcome studies of extended duration are needed.