Angiogenic Factors and Risks of Technique Failure and Cardiovascular Events in Patients Receiving Peritoneal Dialysis

Background: Placental growth factor (PIGF) 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 (sFIt-1) antagonizes PIGF action. Higher levels of PIGF and sFIt-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 PIGF and sFIt-1 with technique survival and cardiovascular events. Methods: We measured serum levels of PIGF and plasma levels of sFIt-1 in 40 PD patients at Nara Medical University. Results: PIGF and sFIt-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 PIGF and sFIt-1 levels were not correlated with total creatinine clearance and total Kt/V. Additionally, both PIGF and sFIt-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 PIGF 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, sFIt-1 levels were not associated with technique survival or cardiovascular events (p = 0.11 and p = 0.10, respectively). Conclusion: Elevated PIGF and sFIt-1 are significantly associated with high transport membrane status. PIGF may be a useful predictor of technique survival and cardiovascular events in PD patients. (C) 2016 S Karger AG, Basel