von Willebrand Factor, ADAMTS13 Activity, and Decline in Kidney Function: A Population Based Cohort Study.
BACKGROUND Altered levels of von Willebrand factor (vWF) and ADAMTS13 can promote thrombosis and disturb blood flow in kidney microcirculations. We investigated the association of serum vWF:ADAMTS13 ratio in relation to decline in kidney function. STUDY DESIGN Prospective cohort study. SETTING PARTICIPANTS 2,479 individuals (mean age, 65.1+ 5.9 [SD] years; 43% men) from the population based Rotterdam Study. PREDICTORS vWF, ADAMTS13, and vWF:ADAMTS13 ratio. OUTCOMES MEASUREMENTS Annual decline in estimated glomerular filtration rate (eGFR) halving of eGFR, and new onset eGFR<60mL/min/1.73m2 were assessed. RESULTS During a median follow up of 11 (range, 7.81 13.57) years, 500 cases of new onset eGFR<60mL/min/1.73m2 occurred. The population had a mean eGFR decline of 0.96+ 0.92mL/min/1.73m2 per year. Higher vWF:ADAMTS13 ratio was associated with steeper annual decline in eGFR (difference, 0.06 [95% CI, 0.09 to 0.02] mL/min/1.73m2 per year) and higher risk for new onset eGFR<60mL/min/1.73m2 (OR, 1.13; 95% CI, 1.01 1.27) Likewise, higher vWF:ADAMTS13 ratio was associated with higher risk for halving of eGFR (OR, 1.40; 95% CI, 1.02 1.93) After adjustment for cardiovascular risk factors and blood group, effect estimates remained the same. LIMITATIONS No data available for albuminuria. Participants were classified based on a single measurement of vWF and ADAMTS13. CONCLUSIONS In this population based study, we showed that higher vWF:ADAMTS13 ratio is associated with decline in kidney function, suggesting a role of elevated prothrombotic factors in the development and progression of kidney disease.
American journal of kidney diseases the official journal of the National Kidney Foundation