Angiogenic Factors and Risks of Technique Failure and Cardiovascular Events in Patients Receiving Peritoneal Dialysis.
BACKGROUND
Placental growth factor (PlGF) is a member of the vascular endothelial growth factor family that acts as a pleiotropic cytokine capable of stimulating angiogenesis and accelerating atherogenesis. Soluble fms-like tyrosine kinase-1 (sFlt-1) antagonizes PlGF action. Higher levels of PlGF and sFlt-1 have been associated with cardiovascular events in patients with chronic kidney disease, yet little is known about their relationship with adverse outcomes in patients on peritoneal dialysis (PD). The aim of this study was to investigate the association of PlGF and sFlt-1 with technique survival and cardiovascular events.


METHODS
We measured serum levels of PlGF and plasma levels of sFlt-1 in 40 PD patients at Nara Medical University.


RESULTS
PlGF and sFlt-1 levels were significantly correlated with the dialysate-to-plasma ratio of creatinine (r = 0.342, p = 0.04 and r = 0.554, p < 0.001) although PlGF and sFlt-1 levels were not correlated with total creatinine clearance and total Kt/V. Additionally, both PlGF and sFlt-1 levels were significantly higher in patients with high transport membranes compared to those without (p = 0.039 and p < 0.001, respectively). Patients with PlGF levels above the median had lower technique survival and higher incidence of cardiovascular events than patients with levels below the median, with hazard ratios of 11.9 and 7.7, respectively, in univariate Cox regression analysis. However, sFlt-1 levels were not associated with technique survival or cardiovascular events (p = 0.11 and p = 0.10, respectively).


CONCLUSIONS
Elevated PlGF and sFlt-1 are significantly associated with high transport membrane status. PlGF may be a useful predictor of technique survival and cardiovascular events in PD patients.
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Masaru
M
Matsui
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Ken-Ichi
K
Samejima
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Yukiji
Y
Takeda
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Katsuhiko
K
Morimoto
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Miho
M
Tagawa
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Kenji
K
Onoue
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Satoshi
S
Okayama
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Hiroyuki
H
Kawata
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Rika
R
Kawakami
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Yasuhiro
Y
Akai
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Hiroyuki
H
Okura
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan; Department of Regulatory Medicine for Blood Pressure, Nara Medical University, Kashihara, Japan.
Yoshihiko
Y
Saito
Cardiovascular events; Peritoneal dialysis; Placental growth factor; Soluble fms-like tyrosine kinase-1; Technique survival