Serum VEGF-C levels as a candidate biomarker of hypervolemia in chronic kidney disease

Abstract

Attaining and maintaining optimal “dry weight” is one of the principal goals during maintenance hemodialysis (MHD). Recent studies have shown a close relationship between Na+ load and serum vascular endothelial growth factor-C (VEGF-C) levels; thus, we aimed to investigate the role of VEGF-C as a candidate biomarker of hypervolemia. Physical examination, basic laboratory tests, N-terminal pro b-type natriuretic peptide (NT-ProBNP), echocardiography, and bioimpedance spectroscopy data of 3 groups of study subjects (euvolemic MHD patients, healthy controls, and hypervolemic chronic kidney disease [CKD] patients) were analyzed. Research data for MHD patients were obtained both before the first and after the last hemodialysis (HD) sessions of the week. Data of 10 subjects from each study groups were included in the analysis. Serum VEGF-C levels were significantly higher in hypervolemic CKD versus in MHD patients both before the first and after the last HD sessions (P = .004 and P = .000, respectively). Healthy controls had serum VEGF-C levels similar to and higher than MHD patients before the first and after the last HD sessions of the week (P = .327 and P = .021, respectively). VEGF-C levels were correlated with bioimpedance spectroscopy results (r2 0.659, P = .000) and edema (r2 0.494, P =0.006), but not with ejection fraction (EF) (r2 −0.251, P = .134), blood pressures (systolic r2 0.037, P = 0.824, diastolic r2 −0.067, P = .691), and NT-ProBNP (r2 −0.047, P = .773). These findings suggest that serum VEGF-C levels could be a potential new biomarker of hypervolemia. The lack of correlation between VEGF-C and EF may hold a promise to eliminate this common confounder. Further studies are needed to define the clinical utility of VEGF-C in volume management.

Comparison of lung ultrasound and other volumetric methods in peritoneal dialysis patients

“…There is one report showing relationship VEGF-C levels with volume status in hemodialysis patients. [ 9 ] Highest VEGF-C levels were found in CKD patients at the predialysis stage with obvious hypervolemia. Its level was decreased after fluid removal in maintenance hemodialysis patient group.…”

“…The result is hypertonic sodium accumulation in the skin which is accepted as a buffer mechanism maintaining blood pressure homeostasis. [ 8 ] Serum VEGF-C levels had been found as a promising marker of hypervolemia in a hemodialysis patient cohort by Sahutoglu et al [ 9 ]…”

Quality assessment of unsaturated iron-binding protein capacity in Iraqi patients undergoing hemodialysis

“…Excessive dehydration leads to hypervolemia and edema, and weak itching in the patients undergoing dialysis. [ 24 ] Hypervolemia and defect in cardiac system are almost certainly widespread because of impaired tissue perfusion without general clinical signs. [ 25 26 ] Creatinine in the blood is used as an indicator to estimate renal function; it is influenced by many factors including glomerular filtration, such as malabsorption, and some drugs that may interfere with tubular creatinine secretion.…”

Risks of female genital tract related cancers (gynecological cancers) or breast cancer in women with and without chronic kidney disease

“…CKD is a major global heath burden because of its high prevalence and associated risk of ESRD, cardiovascular disease (CVD) events, such as congestive heart failure, stroke, myocardial infarction, peripheral artery disease, and premature death. [ 19 , 20 ] These adverse events have almost certainly underestimated the disease burden of CKD because it probably only captures deaths due to ESRD. [ 15 ] Although it is well documented that CVD causes most deaths in patients with CKD, [ 15 , 19 ] and cancer might be a relatively rare cause of death among patients on dialysis, who primarily died of CVD or infectious causes, [ 21 , 22 ] therefore, the risk of cancer is often overlooked.…”

“…[ 19 , 20 ] These adverse events have almost certainly underestimated the disease burden of CKD because it probably only captures deaths due to ESRD. [ 15 ] Although it is well documented that CVD causes most deaths in patients with CKD, [ 15 , 19 ] and cancer might be a relatively rare cause of death among patients on dialysis, who primarily died of CVD or infectious causes, [ 21 , 22 ] therefore, the risk of cancer is often overlooked. For the majority of women with CKD, most of whom might have much comorbidity, it is rationale to suppose that these CKD women have limited life expectancy, contributing to neglecting cancer screening.…”