Associations of Serum Insulin-Like Growth Factor 1 with New Cardiovascular Events and Subsequent Death in Hemodialysis Patients: The DREAM Cohort
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- Nakaya Rino
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
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- Shoji Tetsuo
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
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- Nagata Yuki
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
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- Nakatani Shinya
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
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- Mori Katsuhito
- Department of Nephrology, Osaka City University Graduate School of Medicine
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- Morioka Tomoaki
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
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- Tsujimoto Yoshihiro
- Division of Internal Medicine, Aijinkai Healthcare Corporation Inoue Hospital
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- Emoto Masanori
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine Department of Nephrology, Osaka City University Graduate School of Medicine
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<p> Aim: 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.</p><p>Methods: 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.</p><p> Results: 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.</p><p>Conclusions: 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.</p>
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- Ｊｏｕｒｎａｌ ｏｆ Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ ａｎｄ Ｔｈｒｏｍｂｏｓｉｓ
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Ｊｏｕｒｎａｌ ｏｆ Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ ａｎｄ Ｔｈｒｏｍｂｏｓｉｓ 29 (8), 1153-1165, 2022-08-01
一般社団法人 日本動脈硬化学会