IGF-1 and survival in ESRD.

Abstract

BACKGROUND AND OBJECTIVES:

IGF-1 deficiency links to malnutrition in CKD patients; however, it is not clear to what extent it associates with survival among these patients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Serum IGF-1 and other biochemical, clinical (subjective global assessment), and densitometric (dual energy x-ray absorptiometry) markers of nutritional status and mineral and bone metabolism were measured in a cohort of 365 Swedish clinically stable CKD stage 5 patients (median age of 53 years) initiating dialysis between 1994 and 2009; in 207 patients, measurements were also taken after 1 year of dialysis. Deaths were registered during a median follow-up of 5 years. Associations of mortality with baseline IGF-1 and changes of IGF-1 after 1 year of dialysis were evaluated by Cox models.

RESULTS:

At baseline, IGF-1 concentrations associated negatively with age, diabetes mellitus, cardiovascular disease, poor nutritional status, IL-6, and osteoprotegerin and positively with body fat mass, bone mineral density, serum phosphate, calcium, and fibroblast growth factor-23. At 1 year, IGF-1 had increased by 33%. In multivariate regression, low age, diabetes mellitus, and high serum phosphate and calcium associated with IGF-1 at baseline, and in a mixed model, these factors, together with high fat body mass, associated with changes of IGF-1 during the first 1 year of dialysis. Adjusting for calendar year of inclusion, age, sex, diabetes mellitus, cardiovascular disease, IL-6, and poor nutritional status, a 1 SD higher level of IGF-1 at baseline associated with lower mortality risk (hazard ratio, 0.57; 95% confidence interval, 0.32 to 0.98). Persistently low or decreasing IGF-1 levels during the first 1 year on dialysis predicted worse survival (adjusted hazard ratio, 2.19; 95% confidence interval, 1.06 to 4.50).

CONCLUSION:

In incident dialysis patients, low serum IGF-1 associates with body composition and markers of mineral and bone metabolism, and it predicts increased mortality risk.

• Authors: Ting Jia, Thiane Gama Axelsson, Olof Heimbürger, Peter Bárány, Bengt Lindholm, Peter Stenvinkel, Abdul Rashid Qureshi
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 9 Issue 1 Pg. 120-7 (Jan 2014) ISSN: 1555-905X [Electronic] United States
• PMID: 24178975 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• IGF1 protein, human
• Insulin-Like Growth Factor I

Topics

• Adult
• Aged
• Biomarkers (blood)
• Body Composition
• Bone Remodeling
• Chi-Square Distribution
• Cross-Sectional Studies
• Down-Regulation
• Female
• Humans
• Insulin-Like Growth Factor I (analysis)
• Kaplan-Meier Estimate
• Kidney Failure, Chronic (blood, diagnosis, mortality, therapy)
• Longitudinal Studies
• Male
• Middle Aged
• Multivariate Analysis
• Nutritional Status
• Proportional Hazards Models
• Renal Dialysis
• Risk Factors
• Sweden (epidemiology)
• Time Factors
• Treatment Outcome