Growth Differentiation Factor 15 in Children with Chronic Kidney Disease and after Renal Transplantation

Growth differentiation factor 15 (GDF-15) is strongly associated with cardiovascular disease (CVD). The aim of our study was to evaluate plasma and urinary levels of GDF-15 after pediatric renal transplantation (Rtx) and in children with chronic kidney disease (CKD) and its associations to cardiovascular risk factors. In this cross-sectional study, GDF-15 was measured in plasma and urine from 53 children with a renal transplant and 83 children with CKD and related to cardiovascular risk factors (hypertension, obesity, and cholesterol) and kidney function. Forty healthy children served as a control group. Plasma levels of GDF-15 (median and range) for a Tx (transplantation) cohort, CKD cohort, and healthy controls were, respectively, 865？ng/L (463-3039？ng/L), 508？ng/L (183-3279？ng/L), and 390？ng/L (306-657？ng/L). The CKD and Tx cohorts both had significantly higher GDF-15 levels than the control group ( ). Univariate associations between GDF-15 and hyperuricemia ( ), elevated triglycerides ( ), low HDL ( ), and obesity ( ) were found. However, mGFR ( ) and hemoglobin ( ) were the only significant predictors of GDF-15 in an adjusted analysis. Urinary GDF-15/creatinine ratios were 448？ng/mmol (74–5013？ng/mmol) and 540？ng/mmol (5–14960？ng/mmol) in the Tx cohort and CKD cohort, respectively. In the CKD cohort, it was weakly correlated to mGFR ( , ). Plasma levels of GDF-15 are elevated in children with CKD and after Rtx. The levels were not associated with traditional cardiovascular risk factors but strongly associated with renal function