Abstract: SA-PO152

Low Plasma Insulin-Like Growth Factor-1 Associates with Increased Mortality in CKD Patients with Reduced Muscle Strength

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism

Authors

  • Zhimin, Chen, Karolinska Institutet, Stockholm, Sweden
  • Lindholm, Bengt, Karolinska Institutet, Stockholm, Sweden
  • Heimburger, Olof, Karolinska Institutet, Stockholm, Sweden
  • Barany, Peter F., Karolinska Institutet, Stockholm, Sweden
  • Stenvinkel, Peter, Karolinska Institutet, Stockholm, Sweden
  • Chen, Jianghua, Zhejiang University, Hangzhou, China
  • Qureshi, Abdul Rashid Tony, Karolinska Institutet, Stockholm, Sweden
Background

Chronic kidney disease (CKD) leads to metabolic and nutritional abnormalities including resistance to insulin-like growth factor-1 (IGF-1) action. Low plasma IGF-1 concentration as well as low handgrip strength (HGS), a reliable and easy-to-perform nutritional parameter, are independent predictors of increased mortality in CKD patients (pts). We hypothesized that low muscle strength enhances the negative impact of low IGF-1 on survival in CKD.

Methods

We included 685 CKD pts (62% males; median age 58 years) including 75 CKD 3-4 pts, 361 incident dialysis pts, 70 prevalent peritoneal dialysis pts and 179 prevalent hemodialysis pts. Baseline measurements of IGF-1, HGS, nutritional status (by subjective global assessment, SGA), lean body mass index (LBMI), and metabolic and inflammatory biomarkers potentially linked to IGF-1 were analysed in relation to mortality during follow up period of up to 5 years during which 208 pts (30.4%) died. We compared survival in four groups with high or low (cut-offs defined by ROC curve analysis) levels of IGF-1 and HGS.

Results

Pts with low IGF-1 were older, had lower body mass index (BMI), HGS and LBMI, more likely to have diabetes, CVD and malnutrition (SGA >1), and had sensitivity C-reactive protein (hsCRP) levels. During 5 years of follow-up, 208 pts (30.4%) died. Pts with Low IGF-1 + Low HGS had markedly increased mortality rate: In competing-risks regression analysis, sub-hazard ratio (SHR) of pts with Low HGS + Low IGF-1 was 2.3 times higher than for pts with High HGS + Low IGF-1. Low IGF-1 + Low HGS was independently associated with all-cause mortality after adjustments for age, sex, diabetes, CVD, SGA, smoking, hsCRP, albumin and LBMI.

Conclusion

Low IGF-1 together with low HGS - but not low IGF-1 together with high HGS - was independently associated with increased all-cause mortality suggesting that the effect of IGF-1 on mortality in CKD patients depends on nutritional status.

Funding

  • Commercial Support