| Autor: |
den Hoedt CH; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands. c.h.denhoedt@erasmusmc.nl.; Department of Internal Medicine, Maasstad Hospital, Rotterdam 3079 DZ, The Netherlands. c.h.denhoedt@erasmusmc.nl., van Gelder MK; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands. m.k.vangelder-5@umcutrecht.nl., Grooteman MP; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Nephrology, Amsterdam 1081 HV, The Netherlands. mpc.grooteman@vumc.nl., Nubé MJ; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Nephrology, Amsterdam 1081 HV, The Netherlands. m.nube@spaarnegasthuis.nl., Blankestijn PJ; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands. P.J.Blankestijn@umcutrecht.nl., Goldschmeding R; Department of Pathology, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands. R.Goldschmeding@umcutrecht.nl., Kok RJ; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht 3584 CG, The Netherlands. R.J.Kok@uu.nl., Bots ML; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, 3508 GA Utrecht, The Netherlands. M.L.Bots@umcutrecht.nl., van den Dorpel MA; Department of Internal Medicine, Maasstad Hospital, Rotterdam 3079 DZ, The Netherlands. DorpelM@maasstadziekenhuis.nl., Gerritsen KGF; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands. K.G.F.Gerritsen@umcutrecht.nl. |
| Abstrakt: |
Connective tissue growth factor (CTGF) plays a key role in the pathogenesis of tissue fibrosis. The aminoterminal fragment of CTGF is a middle molecule that accumulates in chronic kidney disease. The aims of this study are to explore determinants of plasma CTGF in hemodialysis (HD) patients, investigate whether CTGF relates to all-cause mortality in HD patients, and investigate whether online-hemodiafiltration (HDF) lowers CTGF. Data from 404 patients participating in the CONvective TRAnsport STudy (CONTRAST) were analyzed. Patients were randomized to low-flux HD or HDF. Pre-dialysis CTGF was measured by sandwich ELISA at baseline, after six and 12 months. CTGF was inversely related in multivariable analysis to glomerular filtration rate (GFR) ( p < 0.001) and positively to cardiovascular disease (CVD) ( p = 0.006), dialysis vintage ( p < 0.001), interleukin-6 ( p < 0.001), beta-2-microglobulin ( p = 0.045), polycystic kidney disease ( p < 0.001), tubulointerstitial nephritis ( p = 0.002), and renal vascular disease ( p = 0.041). Patients in the highest quartile had a higher mortality risk compared to those in the lowest quartile (HR 1.7, 95% CI: 1.02-2.88, p = 0.043). HDF lowered CTGF with 4.8% between baseline and six months, whereas during HD, CTGF increased with 4.9% ( p < 0.001). In conclusion, in HD patients, CTGF is related to GFR, CVD and underlying renal disease and increased the risk of all-cause mortality. HDF reduces CTGF. |
