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Kidney Week

Abstract: FR-PO423

GDF-15 and FGF-23 Are Associated with Mortality in Type 2 Diabetic Patients with Microalbuminuria

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Frimodt-møller, Marie, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Von Scholten, Bernt Johan, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Reinhard, Henrik, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Hansen, Tine, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Persson, Frederik, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Parving, Hans-Henrik, Rigshospitalet, Copenhagen, Denmark
  • Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark
Background

We evaluated growth differentiation factor 15 (GDF-15) and fibroblast growth factor 23 (FGF23) reflecting different aspects of renal pathophysiology as determinants of decline in estimated glomerular filtration rate (eGFR), incident cardiovascular disease (CVD) and all-cause mortality in patients with type 2 diabetes (T2D) and microalbuminuria, but without clinical coronary artery disease

Methods

Prospective study including 200 patients. GDF-15 and FGF23 were measured at baseline. Adjusted Cox models included sex, age, LDL cholesterol, smoking, HbA1c, creatinine, systolic blood pressure urine albumin excretion rate (UAER) and for FGF23 also 25(OH)vitamin D . Main outcome measures: A decline in eGFR of >30%, at any time point during follow-up was the predefined endpoint of CKD progression. Hazard ratios (HR) are provided per 1 SD increment of log-transformed values of the biomarkers.

Results

Patients were (± SD) 59 ± 9 years old, eGFR 91.1 ± 18.3 ml/min/1.73m2 and UAER (IQR) 103 (39–230) mg/24-h. During a median 6.1 years follow-up, there were 40 incident CVD events, 26 deaths and a total of 42 patients reached the renal endpoint after 4.9 years (median). Higher GDF-15 was a determinant of decline in eGFR >30% in unadjusted (HR (95% CI) 1.7 (1.3-2.4); p=0.001) and adjusted (HR 1.7 (1.1-2.5); p=0.018) models, a predictor of CVD in the unadjusted model (HR 1.4 (1.0-1.9); p=0.034) and of all-cause mortality in unadjusted (HR 1.8 (1.3-2.6); p<0.001) and adjusted (HR 1.9 (1.2-2.9); p=0.003) models. Higher FGF-23 was associated with all-cause mortality in unadjusted (HR 1.5 (1.1-2.0); p=0.010) and adjusted (HR 1.6 (1.1-2.2); p=0.011) models.

Conclusion

In patients with T2D and microalbuminuria, GDF-15 was independently associated with decline in kidney function and all-cause mortality, and higher FGF23 was associated with all-cause mortality.