Plasma activin a rises with declining kidney function and is independently associated with mortality in patients with chronic kidney disease

Abstract Background Plasma (p-)activin A is elevated in Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Activin A inhibition ameliorates CKD-MBD complications (vascular calcification and bone disease) in rodent CKD models. We examined if p-activin A was associated with major adverse cardiovascular events (MACE), all-cause mortality, and CKD-MBD complications in CKD patients. Methods The study included 916 participants (741 patients and 175 controls) from the prospective Copenhagen CKD cohort. Comparisons of p-activin A with eGFR, coronary, and thoracic aorta Agatston scores, and bone mineral density (BMD) were evaluated by univariable linear regression using Spearman's rank correlation, analysis of covariance, and ordinal logistic regression with adjustments. Association of p-activin A with rates of MACE and all-cause mortality was evaluated by the Aalen-Johansen or Kaplan-Meier estimator, with subsequent multiple Cox regression analyses. Results P-activin A was increased by CKD stage 3 (124 to 225pg/mL, P < 0.001) and correlated inversely with eGFR (r=−0.53, P < 0.01). P-activin A was associated with all-cause mortality (97 events, HR 1.55 [1.04;2.32], P < 0.05) after adjusting for age, sex, diabetes mellitus (DM), and eGFR. Median follow-up was 4.36 (IQR 3.64–4.75) years. The association with MACE was not significant after eGFR adjustment. Agatston scores and BMD were not associated with p-activin A. Conclusion P-activin A increased with declining kidney function and was associated with all-cause mortality independently of age, sex, DM, and eGFR. No association with MACE, vascular calcification, or BMD was demonstrated.