HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: dc07-2469v1 31/6/1177    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Nguyen, T. Q. Articles by Goldschmeding, R. PubMed PubMed Citation Articles by Nguyen, T. Q. Articles by Goldschmeding, R. Social Bookmarking                What's this?

Plasma Connective Tissue Growth Factor Is an Independent Predictor of End-Stage Renal Disease and Mortality in Type 1 Diabetic Nephropathy

¹ Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
² Steno Diabetes Center, Gentofte, Denmark
³ FibroGen, South San Francisco, California
⁴ Nephrology, Nagoya University School of Medicine, Nagoya, Japan
⁵ Endocrinology, Rigshospitalet, Copenhagen, Denmark
⁶ Faculty of Health Science, Aarhus University, Aarhus, Denmark

Corresponding author: R. Goldschmeding, MD, PhD, UMC Utrecht, Department of Pathology, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands. E-mail: r.goldschmeding{at}umcutrecht.nl

OBJECTIVE—We evaluated the predictive value of baseline plasma connective tissue growth factor (CTGF) in a prospective study of patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS—Subjects were 198 type 1 diabetic patients with established diabetic nephropathy and 188 type 1 diabetic patients with persistent normoalbuminuria. Follow-up time was 12.8 years. Prediction of end-stage renal disease (ESRD) and mortality by plasma CTGF was analyzed in conjunction with conventional risk factors.

RESULTS—Plasma CTGF was higher in patients with nephropathy than in patients with normoalbuminuria (median 381 [interquartile range 270–630] vs. 235 [168–353] pmol/l). In patients with nephropathy, elevated plasma CTGF was an independent predictor of ESRD (covariate-adjusted hazard ratio [HR] 1.6 [95% CI 1.1–2.5]) and correlated with the rate of decline in glomerular filtration rate (GFR) (cumulative R = 0.46). Area under the receiver operating characteristic curve for prediction of ESRD was 0.72. Plasma CTGF above a cutoff level of 413 pmol/l predicted ESRD with a sensitivity of 73% and a specificity of 63% and was associated with a higher rate of decline in GFR (mean ± SD 5.4 ± 4.9 vs. 3.3 ± 3.5 ml/min per 1.73 m² per year). Moreover, in patients with nephrotic range albuminuria (>3 g/day), plasma CTGF was the only predictor of ESRD (covariate-adjusted HR 4.5 [2.0–10.4]). Plasma CTGF was an independent predictor also of overall mortality (covariate-adjusted HR 1.4 [1.1–1.7]). In contrast, in normoalbuminuric patients, plasma CTGF did not correlate with clinical parameters and did not predict outcome.

CONCLUSIONS—Plasma CTGF contributes significantly to prediction of ESRD and mortality in patients with type 1 diabetic nephropathy.

Abbreviations: CTGF, connective tissue growth factor • ESRD, end-stage renal disease • GFR, glomerular filtration rate • ROC, receiver operating characteristic • UAE, urinary albumin excretion

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?