Connective Tissue Growth Factor Is Related to All-cause Mortality in Hemodialysis Patients and Is Lowered by On-line Hemodiafiltration: Results from the Convective Transport Study

• Published in: Toxins 2019-05, Vol.11 (5), p.268
• Main Authors: den Hoedt, Claire H, van Gelder, Maaike K, Grooteman, Muriel P, Nubé, Menso J, Blankestijn, Peter J, Goldschmeding, Roel, Kok, Robbert Jan, Bots, Michiel L, van den Dorpel, Marinus A, Gerritsen, Karin G F
• Format: Article
• Language: English
• Subjects: Aged; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Cause of Death; CCN intercellular signalling proteins; Connective tissue; Connective tissue growth factor; Connective Tissue Growth Factor - blood; Connective tissues; convection; Diabetes; Dialysis; end stage kidney disease; Female; Fibrosis; Glomerular Filtration Rate; Growth factors; haemodiafiltration; haemodialysis; Health risks; Heart diseases; Hemodialysis; Humans; Interleukin 6; Kidney diseases; Kidney Diseases - blood; Kidney Diseases - mortality; Kidney Diseases - physiopathology; Kidneys; Male; Middle Aged; Mortality; Mortality risk; Nephritis; Pathogenesis; Patients; Peritoneal dialysis; Plasma; Polycystic kidney; Renal Dialysis; Vascular diseases
• ISSN: 2072-6651; 2072-6651
• DOI: 10.3390/toxins11050268

Connective tissue growth factor (CTGF) plays a key role in the pathogenesis of tissue fibrosis. The aminoterminal fragment of CTGF is a middle molecule that accumulates in chronic kidney disease. The aims of this study are to explore determinants of plasma CTGF in hemodialysis (HD) patients, investigate whether CTGF relates to all-cause mortality in HD patients, and investigate whether online-hemodiafiltration (HDF) lowers CTGF. Data from 404 patients participating in the CONvective TRAnsport STudy (CONTRAST) were analyzed. Patients were randomized to low-flux HD or HDF. Pre-dialysis CTGF was measured by sandwich ELISA at baseline, after six and 12 months. CTGF was inversely related in multivariable analysis to glomerular filtration rate (GFR) ( < 0.001) and positively to cardiovascular disease (CVD) ( = 0.006), dialysis vintage ( < 0.001), interleukin-6 ( < 0.001), beta-2-microglobulin ( = 0.045), polycystic kidney disease ( < 0.001), tubulointerstitial nephritis ( = 0.002), and renal vascular disease ( = 0.041). Patients in the highest quartile had a higher mortality risk compared to those in the lowest quartile (HR 1.7, 95% CI: 1.02-2.88, = 0.043). HDF lowered CTGF with 4.8% between baseline and six months, whereas during HD, CTGF increased with 4.9% ( < 0.001). In conclusion, in HD patients, CTGF is related to GFR, CVD and underlying renal disease and increased the risk of all-cause mortality. HDF reduces CTGF.