von Willebrand Factor, ADAMTS13 Activity, and Decline in Kidney Function: A Population-Based Cohort Study

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• 作者：Sanaz Sedaghat ; PhD¹ ; ^&lowast ; ; Paul S. de Vries ; MSc¹ ; ^&lowast ; ; Johan Boender ; MD² ; Michelle A.H. Sonneveld ; PhD² ; ³ ; Ewout J. Hoorn ; MD ; PhD⁴ ; Albert Hofman ; MD ; PhD¹ ; Moniek P.M. de Maat ; PhD² ; Oscar H. Franco ; MD ; PhD¹ ; M. Arfan Ikram ; MD ; PhD¹ ; ³ ; ⁵ ; Frank W.G. Leebeek ; MD ; PhD² ; Abbas Dehghan ; MD ; PhD¹ ; ^{a.dehghan@erasmusmc.nl" class="auth_mail" title="E-mail the corresponding author}
• 关键词：von Willebrand factor (vWF) ; ADAMTS13 activity ; von Willebrand factor protease ; kidney disease ; disease progression ; estimated glomerular filtration rate (eGFR) ; eGFR trajectory ; prothrombotic factors
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：68
• 期：5
• 页码：726-732
• 全文大小：336 K

文摘

Altered levels of von Willebrand factor (vWF) and ADAMTS13 can promote thrombosis and disturb blood flow in kidney microcirculations. We investigated the association of serum vWF:ADAMTS13 ratio in relation to decline in kidney function.

Study Design

Prospective cohort study.

Setting & Participants

2,479 individuals (mean age, 65.1 ± 5.9 [SD] years; 43% men) from the population-based Rotterdam Study.

Predictors

vWF, ADAMTS13, and vWF:ADAMTS13 ratio.

Outcomes & Measurements

Annual decline in estimated glomerular filtration rate (eGFR), halving of eGFR, and new-onset eGFR < 60 mL/min/1.73 m² were assessed.

Results

During a median follow-up of 11 (range, 7.81-13.57) years, 500 cases of new-onset eGFR < 60 mL/min/1.73 m² occurred. The population had a mean eGFR decline of 0.96 ± 0.92 mL/min/1.73 m² per year. Higher vWF:ADAMTS13 ratio was associated with steeper annual decline in eGFR (difference, −0.06 [95% CI, −0.09 to −0.02] mL/min/1.73 m² per year) and higher risk for new-onset eGFR < 60 mL/min/1.73 m² (OR, 1.13; 95% CI, 1.01-1.27). Likewise, higher vWF:ADAMTS13 ratio was associated with higher risk for halving of eGFR (OR, 1.40; 95% CI, 1.02-1.93). After adjustment for cardiovascular risk factors and blood group, effect estimates remained the same.

Limitations

No data available for albuminuria. Participants were classified based on a single measurement of vWF and ADAMTS13.

Conclusions

In this population-based study, we showed that higher vWF:ADAMTS13 ratio is associated with decline in kidney function, suggesting a role of elevated prothrombotic factors in the development and progression of kidney disease.