title: Prognostic Impact of Placental Growth Factor on Mortality and Cardiovascular Events in Dialysis Patients.
abstract: BACKGROUND
  Placental growth factor (PlGF), a member of the vascular endothelial growth factor (VEGF) family, has recently emerged as a predictor of survival and cardiovascular risk. Along with others, we have shown an independent association between PlGF and cardiovascular events in CKD patients, but not much is known about patients receiving dialysis.
  
  
  METHODS
  We studied 205 dialysis patients undergoing cardiac catheterization at the Nara Medical University between April 1, 2004, and December 31, 2012. Serum levels of PlGF and VEGF were measured with ELISA in all the patients.
  
  
  RESULTS
  During a median follow-up of 20 months, 121 participants died from any cause or experienced a cardiovascular event. In the fully adjusted analysis, having an above-median PlGF or VEGF level was associated with a hazards ratio for adverse outcomes of 2.55 (1.72-3.83) and 1.39 (0.95-2.04), respectively. Using a multimarker strategy in a model with age, serum albumin, history of coronary artery disease, brain natriuretic peptide and PlGF, patients with 2, 3 and 4 positive markers had a 3.82-, 5.77- and 6.59-fold higher risk of mortality or a cardiovascular event, respectively, compared to those with no positive markers. The model with PlGF had a significantly higher c-statistic, integrated discrimination improvement index and category-free net reclassification improvement index than the model without PlGF.
  
  
  CONCLUSIONS
  PlGF is independently associated with mortality and cardiovascular events, but the association between VEGF and adverse events was attenuated with covariate adjustment. The addition of PlGF to models with established clinical predictors provides additional useful prognostic information in patients receiving dialysis.
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Matsui
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Samejima
authors.forename: Yukiji
authors.initials: Y
authors.lastname: Takeda
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanabe
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Morimoto
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okamoto
authors.forename: Miho
authors.initials: M
authors.lastname: Tagawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Onoue
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okayama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawata
authors.forename: Rika
authors.initials: R
authors.lastname: Kawakami
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Akai
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000401:mortality; D001014:Aortic Aneurysm / Q000453:epidemiology / Q000401:mortality; D001018:Aortic Diseases / Q000453:epidemiology / Q000401:mortality; D001019:Aortic Rupture / Q000453:epidemiology / Q000401:mortality; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000401:mortality; D000072483:Placenta Growth Factor; D011257:Pregnancy Proteins / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
chemical_list: C000608036:PGF protein, human; D011257:Pregnancy Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D020097:Natriuretic Peptide, Brain; D000072483:Placenta Growth Factor