Growth differentiation factor-15 (GDF-15), a cardiovascular biomarker linked with oxidative stress, inflammation, and kidney function, can improve prediction of major bleeding risk in patients receiving hemodialysis, new study findings suggest.

GDF-15 is already an established biomarker for bleeding in patients with atrial fibrillation and has been incorporated into the ABC-bleeding risk score.

In The Vienna InVestigation of AtriaL Fibrillation and thromboembolism in hemoDIalysis (VIVALDI) study, investigators measured GDF-15 in 594 patients on hemodialysis (of whom a quarter had atrial fibrillation). Virtually all patients (99.1%) had a GDF-15 level exceeding 1800 ng/L, which is the highest-risk group among cardiovascular patients. The median GDF-15 level was 5475 ng/L.

Continue Reading

With each doubling of GDF-15 levels, the risk for major bleeding significantly increased 31%, Cihan Ay, MD, of Medical University of Vienna in Austria and colleagues reported in Nephrology Dialysis Transplantation. Major bleeding included fatal bleeding, bleeding in a critical area or organ, and bleeding leading to transfusion of 2 or more units of red blood cells.

GDF-15 improved discrimination of the HAS-BLED score from 0.61 to 0.68, the investigators reported.

Each doubling of GDF-15 also was significantly associated with a 47% increased risk of major adverse cardiovascular events, driven by cardiac death, and a 58% increased risk of all-cause mortality, the investigators reported. It was not associated with the risk for thromboembolism.

“Potential clinical settings for GDF-15 include (i) decision on dialysis treatment modalities (e.g., anticoagulant regimen during dialysis, and type of dialysis, as peritoneal dialysis is associated with lower bleeding rates compared to HD), (ii) characterization of high-risk patients who would benefit from close monitoring and modification of risk factors for bleeding, and (iii) identification of patients that might benefit from long-term anticoagulant therapy,” Dr Ay’s team wrote.


Nopp S, Königsbrügge O, Schmaldienst S, et al. Growth differentiation factor-15 (GDF-15) predicts major bleeding, major adverse cardiac events, and mortality in patients with end-stage kidney disease on hemodialysis: findings from the VIVALDI study. Nephrol Dial Transplant. Published online December 6, 2022. doi:10.1093/ndt/gfac321