Placental Growth Factor as a Novel Marker in Uremia-Related Cardiovascular Disease.

for at least a year with a median follow-up period of 20 months. The primary endpoint was death from any cause or a cardiovascular event including non-fatal newly developed CAD, stroke, peripheral arterial disease, aortic disease, and heart failure. During the follow-up period, there were 121 patients who reached a primary endpoint. An above-median PlGF level was associated with a hazard ratio (HR) of 2.55 (1.72–3.83), which was higher than the HR for having an above-median VEGF, 1.39 (0.95–2.04). A multimarker predictive model involving 5 markers, including PlGF, found that 2, 3, and 4 positive markers had a 3.82-, 5.77-, and 6.59-fold higher risk of a primary endpoint. This article concludes that PlGF is both independently and significantly associated with mortality and cardiovascular events and a useful prognostic marker. The strengths of this study include a median follow-up period of 20 months, complete retention of patients with no loss to follow-up, and a high percentage of patients reaching a primary endpoint. During the last decade, PlGF biology has inspired research spanning from pregnancy to cancer to cardiovascular disorders. While VEGF is required for normal development of healthy vasculature, PlGF has a redundant role in health. In fact, mice deficient in PlGF do not display phenotypic abnormalities [4] . PlGF does however have a It has been well established that chronic kidney disease is an independent risk factor for adverse cardiovascular events [1] . The exact etiology of this phenomenon is not known, but the risk is thought to be multifactorial and due to uremia-specific processes that may not respond to traditional cardiovascular preventive strategies. Extensive research has been done to understand the underlying pathophysiology in order to better categorize patients based on risk and to explore preventive therapies. In particular, several novel biomarkers such as carbamylated albumin have been proposed as pathogenic markers mediating excess mortality related to end-stage renal disease (ESRD) [2] . Placental growth factor (PlGF) is a circulating protein that belongs to the family of vascular endothelial growth factors (VEGFs); it is emerging as another promising biomarker. The article by Matsui et al. [3] published in this issue of AJN evaluates the prognostic value of PlGF in predicting mortality and cardiovascular events in ESRD patients on dialysis. They conducted an observational study involving 205 dialysis patients who received a cardiac catheterization; 162 (79% of patients) were on hemodialysis and 43 (21% of patients) were on peritoneal dialysis. Both PlGF and VEGF levels were obtained and echocardiography was obtained within 2 weeks of blood sampling. The patients were followed Published online: September 15, 2015 Nephrology American Journal of