Abstract Number: OC 36.1
Meeting: ISTH 2021 Congress
Background: Patients with end-stage renal disease (ESRD) are at high risk of bleeding, thromboembolism, and death. Optimizing risk assessment in these patients is currently challenging. Growth differentiation factor-15 (GDF-15), an emerging cardiovascular biomarker associated with renal function, yields promising results to improve risk prediction.
Aims: Our objective was to investigate the predictive ability of GDF-15 for risk of bleeding, thromboembolic events, and all-cause mortality in ESRD patients on hemodialysis.
Methods: GDF-15 was measured in 594 patients (mean age: 66 years, 38% women) included in the population-based Vienna InVestigation of Atrial fibrillation and thromboemboLism in patients on hemoDialysIs (VIVALDI) study using Simple Plex assays (Bio-Techne, USA). Patients were prospectively followed for occurrence of bleeding, thromboembolic events (i.e. stroke, TIA, or systemic embolism), and death. The association of GDF-15 with clinical outcomes was investigated in competing risk analysis adjusted for clinical characteristics.
Results: Over a median observation period of 2.5 years, 84 (14.1%) patients suffered from major bleeding, 40 (6.7%) developed a thromboembolic event, and 243 (40.9%) patients died. Patients with GDF-15 levels in the highest quartile were at increased risk of major bleeding (adjusted HR 2.33, 95%CI 1.18-4.59) and all-cause death (adjusted HR 1.98, 95%CI 1.34-2.93) but had a similar thromboembolic risk compared to patients in the lowest quartile (Table 1). One-year cumulative incidence of major bleeding in the lowest vs. highest GDF-15 quartile was 0.7% (95%CI 0.0-2.0) vs. 8.7% (95%CI 4.2-13.3) and one-year mortality was 7.4% (95%CI 3.2-11.6) vs. 22.8% (95%CI 16.1-29.6), respectively. (Figure 1) Further, patients in the highest GDF-15 quartile were at two-fold increased risk (95%CI 1.21-3.54) for developing major adverse cardiac events (i.e. stroke, myocardial infarction, cardiovascular death).
Conclusions: GDF-15, independent of clinical characteristics, predicts risk of major bleeding and all-cause mortality in ESRD patients on hemodialysis and might be a valuable marker to guide treatment decisions in this challenging patient population.
To cite this abstract in AMA style:Nopp S, Königsbrügge O, Pabinger I, Ay C. Growth Differentiation Factor-15 Predicts Major Bleeding, Cardiovascular Events, and All-cause Mortality in Patients with End-stage Renal Disease on Hemodialysis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/growth-differentiation-factor-15-predicts-major-bleeding-cardiovascular-events-and-all-cause-mortality-in-patients-with-end-stage-renal-disease-on-hemodialysis/. Accessed December 7, 2021.
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