Von Willebrand factor, ADAMTS13 and mortality in dialysis patients

Gurbey Ocak; Mark Roest; Marianne C Verhaar; Maarten B Rookmaaker; Peter J Blankestijn; Willem Jan W Bos; Rob Fijnheer; Nathalie C Péquériaux; Friedo W Dekker

doi:10.1186/s12882-021-02420-z

Von Willebrand factor, ADAMTS13 and mortality in dialysis patients

Gurbey Ocak, Mark Roest, Marianne C Verhaar, Maarten B Rookmaaker, Peter J Blankestijn, Willem Jan W Bos, Rob Fijnheer, Nathalie C Péquériaux, Friedo W Dekker

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Abstract

BACKGROUND: Von Willebrand Factor (VWF) multimers are cleaved into smaller and less coagulant forms by the metalloprotease ADAMTS13. The aim of this study was to investigate the association between VWF and ADAMTS13 and mortality in dialysis patients.

METHODS: We prospectively followed 956 dialysis patients. VWF levels and ADAMTS13 activity were measured. Cox proportional hazard analyses were used to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) to investigate the association between quartiles of VWF levels and ADAMTS13 activity and all-cause mortality. HRs were adjusted for age, sex, body mass index, cardiovascular disease, dialysis modality, primary kidney disease, use of antithrombotic medication, systolic blood pressure, albumin, C-reactive protein and residual GFR.

RESULTS: Of the 956 dialysis patients, 288 dialysis patients died within three years (mortality rate 151 per 1000 person-years). The highest quartile of VWF as compared with lower levels of VWF was associated with a 1.4-fold (95 %CI 1.1-1.8) increased mortality risk after adjustment. The lowest quartile of ADAMTS13 activity as compared with other quartiles was associated with a 1.3-fold (95 %CI 1.0-1.7) increased mortality risk after adjustment. The combination of the highest VWF quartile and lowest ADAMTS13 quartile was associated with a 2.0-fold (95 %CI 1.3-3.0) increased mortality risk as compared with the combination of the lowest VWF quartile and highest ADAMTS13 quartile.

CONCLUSIONS: High VWF levels and low ADAMTS13 activity were associated with increased mortality risks in dialysis patients.

Original language	English
Article number	222
Pages (from-to)	1-9
Journal	BMC Nephrology
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s12882-021-02420-z
Publication status	Published - 16 Jun 2021

Keywords

ADAMTS13
Dialysis
Epidemiology
Mortality
Von Willebrand Factor

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title = "Von Willebrand factor, ADAMTS13 and mortality in dialysis patients",

abstract = "BACKGROUND: Von Willebrand Factor (VWF) multimers are cleaved into smaller and less coagulant forms by the metalloprotease ADAMTS13. The aim of this study was to investigate the association between VWF and ADAMTS13 and mortality in dialysis patients.METHODS: We prospectively followed 956 dialysis patients. VWF levels and ADAMTS13 activity were measured. Cox proportional hazard analyses were used to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) to investigate the association between quartiles of VWF levels and ADAMTS13 activity and all-cause mortality. HRs were adjusted for age, sex, body mass index, cardiovascular disease, dialysis modality, primary kidney disease, use of antithrombotic medication, systolic blood pressure, albumin, C-reactive protein and residual GFR.RESULTS: Of the 956 dialysis patients, 288 dialysis patients died within three years (mortality rate 151 per 1000 person-years). The highest quartile of VWF as compared with lower levels of VWF was associated with a 1.4-fold (95 %CI 1.1-1.8) increased mortality risk after adjustment. The lowest quartile of ADAMTS13 activity as compared with other quartiles was associated with a 1.3-fold (95 %CI 1.0-1.7) increased mortality risk after adjustment. The combination of the highest VWF quartile and lowest ADAMTS13 quartile was associated with a 2.0-fold (95 %CI 1.3-3.0) increased mortality risk as compared with the combination of the lowest VWF quartile and highest ADAMTS13 quartile.CONCLUSIONS: High VWF levels and low ADAMTS13 activity were associated with increased mortality risks in dialysis patients.",

keywords = "ADAMTS13, Dialysis, Epidemiology, Mortality, Von Willebrand Factor",

author = "Gurbey Ocak and Mark Roest and Verhaar, {Marianne C} and Rookmaaker, {Maarten B} and Blankestijn, {Peter J} and Bos, {Willem Jan W} and Rob Fijnheer and P{\'e}qu{\'e}riaux, {Nathalie C} and Dekker, {Friedo W}",

note = "Funding Information: The Netherlands Cooperative Study on the Adequacy of Dialysis was supported in part by an unrestricted grant from the Dutch Kidney Foundation. The funding source was involved in neither the collection, interpretation, and analysis of the data nor the decision for the writing and submission of this report for publication. Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = jun,

day = "16",

doi = "10.1186/s12882-021-02420-z",

language = "English",

volume = "22",

pages = "1--9",

journal = "BMC Nephrology",

issn = "1471-2369",

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TY - JOUR

T1 - Von Willebrand factor, ADAMTS13 and mortality in dialysis patients

AU - Ocak, Gurbey

AU - Roest, Mark

AU - Verhaar, Marianne C

AU - Rookmaaker, Maarten B

AU - Blankestijn, Peter J

AU - Bos, Willem Jan W

AU - Fijnheer, Rob

AU - Péquériaux, Nathalie C

AU - Dekker, Friedo W

N1 - Funding Information: The Netherlands Cooperative Study on the Adequacy of Dialysis was supported in part by an unrestricted grant from the Dutch Kidney Foundation. The funding source was involved in neither the collection, interpretation, and analysis of the data nor the decision for the writing and submission of this report for publication. Publisher Copyright: © 2021, The Author(s).

PY - 2021/6/16

Y1 - 2021/6/16

N2 - BACKGROUND: Von Willebrand Factor (VWF) multimers are cleaved into smaller and less coagulant forms by the metalloprotease ADAMTS13. The aim of this study was to investigate the association between VWF and ADAMTS13 and mortality in dialysis patients.METHODS: We prospectively followed 956 dialysis patients. VWF levels and ADAMTS13 activity were measured. Cox proportional hazard analyses were used to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) to investigate the association between quartiles of VWF levels and ADAMTS13 activity and all-cause mortality. HRs were adjusted for age, sex, body mass index, cardiovascular disease, dialysis modality, primary kidney disease, use of antithrombotic medication, systolic blood pressure, albumin, C-reactive protein and residual GFR.RESULTS: Of the 956 dialysis patients, 288 dialysis patients died within three years (mortality rate 151 per 1000 person-years). The highest quartile of VWF as compared with lower levels of VWF was associated with a 1.4-fold (95 %CI 1.1-1.8) increased mortality risk after adjustment. The lowest quartile of ADAMTS13 activity as compared with other quartiles was associated with a 1.3-fold (95 %CI 1.0-1.7) increased mortality risk after adjustment. The combination of the highest VWF quartile and lowest ADAMTS13 quartile was associated with a 2.0-fold (95 %CI 1.3-3.0) increased mortality risk as compared with the combination of the lowest VWF quartile and highest ADAMTS13 quartile.CONCLUSIONS: High VWF levels and low ADAMTS13 activity were associated with increased mortality risks in dialysis patients.

AB - BACKGROUND: Von Willebrand Factor (VWF) multimers are cleaved into smaller and less coagulant forms by the metalloprotease ADAMTS13. The aim of this study was to investigate the association between VWF and ADAMTS13 and mortality in dialysis patients.METHODS: We prospectively followed 956 dialysis patients. VWF levels and ADAMTS13 activity were measured. Cox proportional hazard analyses were used to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) to investigate the association between quartiles of VWF levels and ADAMTS13 activity and all-cause mortality. HRs were adjusted for age, sex, body mass index, cardiovascular disease, dialysis modality, primary kidney disease, use of antithrombotic medication, systolic blood pressure, albumin, C-reactive protein and residual GFR.RESULTS: Of the 956 dialysis patients, 288 dialysis patients died within three years (mortality rate 151 per 1000 person-years). The highest quartile of VWF as compared with lower levels of VWF was associated with a 1.4-fold (95 %CI 1.1-1.8) increased mortality risk after adjustment. The lowest quartile of ADAMTS13 activity as compared with other quartiles was associated with a 1.3-fold (95 %CI 1.0-1.7) increased mortality risk after adjustment. The combination of the highest VWF quartile and lowest ADAMTS13 quartile was associated with a 2.0-fold (95 %CI 1.3-3.0) increased mortality risk as compared with the combination of the lowest VWF quartile and highest ADAMTS13 quartile.CONCLUSIONS: High VWF levels and low ADAMTS13 activity were associated with increased mortality risks in dialysis patients.

KW - ADAMTS13

KW - Dialysis

KW - Epidemiology

KW - Mortality

KW - Von Willebrand Factor

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U2 - 10.1186/s12882-021-02420-z

DO - 10.1186/s12882-021-02420-z

M3 - Article

C2 - 34134634

SN - 1471-2369

VL - 22

SP - 1

EP - 9

JO - BMC Nephrology

JF - BMC Nephrology

IS - 1

M1 - 222

ER -

Von Willebrand factor, ADAMTS13 and mortality in dialysis patients

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