VEGF may be a biomarker of CKD in premature infants with lung disease
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Urinary VEGF levels were lower in premature infants with severe lung disease who developed chronic kidney disease compared with those who did not develop CKD, implying VEGF may be a biomarker of CKD in this patient population.
A speaker at ASN Kidney week presented the study findings.
“Children born prematurely have a three times increased risk of CKD and a 1.5 times increased risk of end-stage kidney disease. Factors which increase the CKD risk in this patient population remain unclear,” Michelle C. Starr, MD, MPH, a pediatric nephrologist at Riley Children’s Health at Indiana University School of Medicine, said. “We’ve found that infants with lung disease are 4.5 times more likely to develop CKD than those without lung disease. However, the relationship between kidney and lung disease remains poorly characterized, particularly in this patient population.”
“We chose to focus on VEGF, which has been previously shown to be measurable in the urine and has been demonstrated to be an important factor in both lung disease development in premature infants and CKD progression,” she said.
Starr and colleagues measured urinary VEGF in 40 infants with severe lung disease using data from the Repaired study, an ancillary of the PENUT trial. Urine from 30 to 34 weeks postmenstrual age was evaluated to determine the exposure of urinary VEGF using the electro-chemiluminescent multi-analyte ELISA (Mesoscale). Researchers used Shapiro-Wilk testing and receiver operating characteristic analysis with Youden’s index to compare values.
“Our outcome was CKD as measured by an eGFR of less than 90 miles per minute for 1.73 m² at 2 years corrected gestational age,” Starr said.
Among the 40 infants in the study, 14 developed CKD. Infants who developed CKD experienced lower urinary VEGF at 30 to 34 weeks postmenstrual age (2.23 log pg/mL vs. 2.63 log pg/mL).
Analyses revealed the area under the curve for VEGF to predict CKD was 0.77, and using a likelihood ratio of 2.32, a threshold of 2.47 log pg/mL provided a sensitivity of 72% and specificity of 70%.
“Our research suggests that in a small cohort of premature infants with severe lung disease, urinary VEGF levels were lower in infants who developed CKD. Additional urinary biomarker analysis in this cohort is ongoing,” Starr said. “Our findings suggest that urinary VEGF may be a predictive biomarker and could serve as a foundation for predicting CKD in premature infants with lung disease.”
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Starr MC, et al. Urinary VEGF as a prognostic biomarker of CKD in premature infants with lung disease. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
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