Part 2:Associations Of Serum Insulin-Like Growth Factor 1 With New Cardiovascular Events And Subsequent Death in Hemodialysis Patients: The DREAM Cohort

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Discussion

We started this study to examine the associations between IGF-1 and the preplanned key outcomes, namely, all-cause mortality, new Cerebrovascular Death events, and death after new Cerebrovascular Death events. A low IGF-1 level was an independent predictor of all-cause death, and it also predicted cardiovascular and non-cardiovascular deaths. IGF-1 level did not have an independent association with new Cerebrovascular Death events, whereas a lower IGF-1 was significantly associated with death after a new Cerebrovascular Death event. Additional analyses showed that IGF-1 was not independently associated with hospitalization for infection, whereas a low IGF-1

Fig.4. Kaplan-Meier curves of death after new CVD events and death after infection

The left panel(A) shows that a lower IGF-1 level was associated with a higher risk of death after Cerebrovascular Death events in an unadjusted model. The right panel(B) shows a similar association between IGF-1 and the risk of death after hospitalization for infection. Abbreviations: CVD, cardiovascular disease; IGF-1,insulin-like growth factor 1;T, tertile.

level predicted death after hospitalization for infection. These results may indicate that a low serum IGF-1 concentration is closely related to vulnerability to fatal outcomes in the case of stressful conditions such as cardiovascular and infectious events in patients undergoing hemodialysis.

Previous studies by Jia et al.12) and Nilsson et al.20)reported that a lower IGF-1 level was an independent predictor of all-cause mortality in patients with kidney failure starting hemodialysis or peritoneal dialysis. These previous studies are consistent with our results in patients on maintenance hemodialysis. In our study, a lower IGF-1 predicts both cardiovascular and non-cardiovascular deaths based on the direct causes of death. Then, one may speculate that a lower IGF-1 could predict both cardiovascular and non-cardiovascular events. However, IGF-1 was not an independent predictor of either new CVD events or hospitalization for infection. Nonetheless, a lower IGF-1 was significantly predictive of shorter survival after Cerebrovascular Disease events and infection.

How can we understand these results? The relative risk of cardiovascular death in patients treated?

Please view the content in Part 3.