Abstract
It is important to identify risk factors related to mortality in end-stage renal disease (ESRD) patients starting renal replacement therapy. Recently, several studies proposed that growth-differentiation factor-15 (GDF-15) is a possible biomarker for the prognosis of patients on maintenance hemodialysis. Here, we investigated the predictive value of serum GDF-15/Albumin ratio on two-year mortality in ESRD patients initiating maintenance hemodialysis. The study was a single center, retrospective study on ESRD patients starting maintenance hemodialysis with a follow-up of two years. All patients completed laboratory test and bioimpedance spectroscopy prior to the initiation of the first dialysis. The patients were stratified into quartiles according to the quartiles of serum GDF-15/Albumin ratio. Among the 159 patients, the mean age was 61.78 ± 12.52 years and median survival was 20.03 ± 7.73 months. The highest GDF-15/Albumin quartile was significantly more associated with the increased risk of all-cause mortality than other quartiles (unadjusted hazard ratio (HR): 8.468, 95% CI 2.981–24.054, p < 0.001). Older age and a higher overhydration state were associated with GDF-15/Albumin ratio. The ROC analysis confirmed that the ability of the GDF-15/Albumin ratio to predict mortality was superior to GDF-15 or albumin alone. In conclusion, the GDF-15/Albumin ratio measured at the initial maintenance hemodialysis is an independent prognostic marker of two-year mortality in ESRD patients.
Highlights
IntroductionChronic kidney disease (CKD) is one of the many increasing global public health issues causing a high socioeconomic burden to health systems [1]
Publisher’s Note: MDPI stays neutralChronic kidney disease (CKD) is one of the many increasing global public health issues causing a high socioeconomic burden to health systems [1]
We investigated the prognostic value of serum growthdifferentiation factor-15 (GDF-15) at the initiation of hemodialysis for all-cause mortality in end-stage renal disease (ESRD) patients and the associations between
Summary
Chronic kidney disease (CKD) is one of the many increasing global public health issues causing a high socioeconomic burden to health systems [1]. The global prevalence of CKD and end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) has been on the rise over the past twenty years [2]. The all-cause mortality of ESRD patients on maintenance hemodialysis has gradually decreased [4] owing to improvements in dialysis technology and the treatment of comorbid conditions. The overall mortality rate of the patients on hemodialysis is still higher than the general population and even higher in the first few months after the initiation of dialysis [4,5,6]. Low serum albumin [9] and volume with regard to jurisdictional claims in published maps and institutional affiliations
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