Predictive and Diagnostic Value of the Angiogenic Proteins in Patients With Chronic Kidney Disease.

IF 6.9 1区 医学 Q1 PERIPHERAL VASCULAR DISEASE Hypertension Pub Date : 2024-11-01 Epub Date: 2024-08-20 DOI:10.1161/HYPERTENSIONAHA.124.23411
Nir Melamed, John C Kingdom, Lei Fu, Paul M Yip, Isabel Arruda-Caycho, Dini Hui, Michelle A Hladunewich
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Abstract

Background: Our objective was to investigate the predictive and diagnostic accuracy of the angiogenic proteins sFlt-1 (soluble fms-like tyrosine kinase-1) and PlGF (placental growth factor) for preterm preeclampsia and explore the relationship between renal function and these proteins.

Methods: We completed a blinded, prospective, longitudinal, observational study of patients with chronic kidney disease followed at a tertiary center (2018-2023). Serum samples were obtained at 3 time points along gestation (planned sampling): 12-16, 18-22, and 28-32 weeks. In addition, samples were obtained whenever preeclampsia was suspected (indicated sampling). sFlt-1 and PlGF levels remained concealed until the study ended. The primary outcome was preterm preeclampsia. The planned and indicated samples were used to estimate the predictive and diagnostic accuracy of the angiogenic proteins, respectively.

Results: Of the 97 participants, 21 (21.6%) experienced preterm preeclampsia. In asymptomatic patients with chronic kidney disease, the angiogenic proteins were predictive of preterm preeclampsia only when sampled in the third trimester, in which case the sFlt-1/PlGF ratio (false positive rate of 37% for a detection rate of 80%) was more predictive than either sFlt-1 or PlGF in isolation. In patients with suspected preeclampsia, the diagnostic accuracy of the sFlt-1/PlGF ratio (false positive rate of 26% for a detection rate of 80%) was higher than that of sFlt-1 and PlGF in isolation. Diminished renal function was associated with increased levels of PlGF.

Conclusions: sFlt-1 and PlGF can effectively predict and improve the diagnostic accuracy for preterm preeclampsia among patients with chronic kidney disease. The optimal sFlt-1/PlGF ratio cutoff to rule out preeclampsia may need to be lower in patients with impaired renal function.

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慢性肾病患者血管生成蛋白的预测和诊断价值
背景:我们的目的是研究血管生成蛋白sFlt-1(可溶性fms样酪氨酸激酶-1)和PlGF(胎盘生长因子)对先兆子痫的预测和诊断准确性,并探讨肾功能与这些蛋白之间的关系:我们完成了一项盲法前瞻性纵向观察研究,研究对象是在一家三级中心随访的慢性肾脏病患者(2018-2023年)。在妊娠期的 3 个时间点采集血清样本(计划采样):12-16周、18-22周和28-32周。sFlt-1和PlGF水平一直隐藏到研究结束。主要结果是先兆子痫。计划样本和指示样本分别用于估计血管生成蛋白的预测准确性和诊断准确性:97名参与者中有21人(21.6%)出现先兆子痫。在无症状的慢性肾病患者中,血管生成蛋白只有在妊娠三个月采样时才能预测先兆子痫,在这种情况下,sFlt-1/PlGF比值(假阳性率为37%,检出率为80%)比单独的sFlt-1或PlGF更具有预测性。在疑似子痫前期患者中,sFlt-1/PlGF 比值(假阳性率为 26%,检出率为 80%)的诊断准确性高于单独使用 sFlt-1 和 PlGF 的诊断准确性。结论:sFlt-1 和 PlGF 可有效预测慢性肾病患者先兆子痫并提高诊断准确性。对于肾功能受损的患者,排除先兆子痫的最佳sFlt-1/PlGF比值临界值可能需要更低。
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来源期刊
Hypertension
Hypertension 医学-外周血管病
CiteScore
15.90
自引率
4.80%
发文量
1006
审稿时长
1 months
期刊介绍: Hypertension presents top-tier articles on high blood pressure in each monthly release. These articles delve into basic science, clinical treatment, and prevention of hypertension and associated cardiovascular, metabolic, and renal conditions. Renowned for their lasting significance, these papers contribute to advancing our understanding and management of hypertension-related issues.
期刊最新文献
Evolutionary Characteristics in Primary Aldosteronism Patients. Rhythmic Contractions of Lymph Vessels and Lymph Flow Are Disrupted in Hypertensive Rats. Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine. Predictive and Diagnostic Value of the Angiogenic Proteins in Patients With Chronic Kidney Disease. GPER Stimulation Attenuates Cardiac Dysfunction in a Rat Model of Preeclampsia.
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