Serum pigment epithelium-derived factor: Relationships with cardiovascular events, renal dysfunction, and mortality in the Veterans Affairs Diabetes Trial (VADT) cohort.

Hunt KJ, Jenkins AJ, Fu D, Stevens D, Ma JX, Klein RL, Azar M, Zhang SX, Lopes-Virella MF, Lyons TJ, VADT Investigators. Serum pigment epithelium-derived factor: Relationships with cardiovascular events, renal dysfunction, and mortality in the Veterans Affairs Diabetes Trial (VADT) cohort. Journal of diabetes and its complications. 2019 Oct 1; 33(10):107410.

Related HSR&D Project(s)

• IIR 16-274 – Impact of neighborhood and workforce deprivation on diabetes outcomes in Veterans: a spatio-temporal analysis

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Abstract:

BACKGROUND: To determine if serum pigment epithelium-derived factor (PEDF) levels predict cardiovascular events, renal dysfunction and mortality in the Veterans Affairs Diabetes Study (VADT). METHODS: PEDF was evaluated in relation to subsequent cardiovascular outcomes, mortality, and renal dysfunction (defined as urinary albumin creatinine ratio (ACR) = 300?mg/g), or chronic kidney disease (CKD) stages 3 (eGFR < 60?ml/min) or 4 (eGFR < 60 and < 30?ml/min respectively). PEDF was measured by ELISA on sera from 881 participants collected a median (range) of 1.7 (0-5.0) years post-baseline, and later, from 832 participants 4.0 (1.5-6.9) years post-baseline. RESULTS: In 743 participants, PEDF was measured at both time-points. PEDF increased over time from (mean?±?SD) 10.5?±?4.03 to 11.0?±?4.86?ng/ml (paired t-test p? = 0.0092). Lower eGFR (p? < 0.01), higher serum creatinine (p? < 0.01) and urinary ACR (p? < 0.01) were associated with increasing PEDF. Multivariate event time models included either one or two follow-up windows (i.e., between first and second PEDF measures; and, when available, from second PEDF measure until study-end). PEDF tertiles were not associated with cardiovascular events, but were significantly associated with all-cause mortality [HR? = 2.00 (1.03, 3.89) comparing first to third tertile] in models adjusted for age, minority status, VADT treatment arm and prior cardiovascular event status. Higher PEDF levels also associated with development of kidney dysfunction with adjusted HRs (95% CI comparing third to first PEDF tertiles: 2.74 (1.71, 4.39) for stage 3 CKD; and 3.84 (95% CI: 1.17, 12.5) for stage 4 CKD. CONCLUSIONS: Over 2-years, higher serum PEDF levels predicted advanced nephropathy in patients with type 2 diabetes.