Growth differentiation factor 15: A novel biomarker with high clinical potential.

Initially considered as a macrophage inhibitor (macrophage inhibitory cytokine-1), growth differentiation factor 15 (GDF-15) has been identified as a pleiotropic protein that plays key roles in prenatal development, in inflammation, in the regulation of cellular responses to stress signals, and in tissue repair after acute injuries in adult life. Multiple studies have revealed that GDF-15, a distant member of the transforming growth factor ß (TGF-ß) family, acts as a critical hormone to regulate lipid and carbohydrate metabolism. Besides its role in the tumorigenesis and diagnosis of cancer, serum GDF-15 concentrations reflect a "systemic response" and are predictive of all-cause mortality. Based on the knowledge from animal studies of its involvement in multiple inflammatory processes, we will focus in this review on the current clinical data on GDF-15 as a biomarker for cardiovascular disease, kidney disease, liver disease, the metabolic syndrome, diabetes mellitus, and sepsis.

Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR<45 mL/min/1.73 m2): a summary document from the European Renal Best Practice Group.

The population of patients with moderate and severe CKD is growing. Frail and older patients comprise an increasing proportion. Many studies still exclude this group, so the evidence base is limited. In 2013 the advisory board of ERBP initiated, in collaboration with European Union of Geriatric Medicine Societies (EUGMS), the development of a guideline on the management of older patients with CKD stage 3b or higher (eGFR >45 mL/min/1.73 m2). The full guideline has recently been published and is freely available online and on the website of ERBP (www.european-renal-best-practice.org). This paper summarises main recommendations of the guideline and their underlying rationales.