Serum growth differentiation factor-15 analysis as a malnutrition marker in hemodialysis patients

Growth differentiation factor (GDF)-15 is related to inflammation and mortality in many conditions. We aimed to determine if an elevated serum GDF-15 level is related to nutritional status of patients on hemodialysis (HD) and mortality.

Routine HD patients (n = 158) were included in the study and followed for 18 months. Some malnutrition/ inflammation scoring indexes (malnutrition/inflammation score (MIS), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI)), biochemical parameters, and GDF-15 were used to build Cox regression multivariate models to study the association with mortality.

Among the patients, 90 (57 %) had a high MIS (≥8), which associates with worse status. The serum GDF-15 level was higher in the same group (p = 0.003). The serum GDF-15 level differentiated malnutrition/inflammation according to the MIS (p = 0.031). Age, GDF15, and C-reactive protein (CRP) were significantly associated with higher all-cause mortality risk. Patients with both age and GDF-15 above the mean had a hazard ratio of 2.76 (p = 0.006) when compared with those both < mean.

In HD patients, the GDF-15 level is increased in worse nutritional status. Beyond the MIS, age, GDF-15 and CRP would be used together to estimate the worse clinical outcome in these patients.