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Pregnancy-Associated Plasma Protein A as an Independent Mortality Predictor in Long-Term Hemodialysis PatientsKalousová M.a · Benáková H.a · Kuběna A.A.a · Dusilová-Sulková S.c · Tesař V.b · Zima T.a
aInstitute of Clinical Biochemistry and Laboratory Diagnostics and bDepartment of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, and cDepartment of Nephrology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic Corresponding Author
Prof. Marta Kalousova, MD, PhD
Institute of Clinical Biochemistry and Laboratory Diagnostics
First Faculty of Medicine, Charles University and General University Hospital
Na Bojišti 3, CZ–121 08 Prague 2 (Czech Republic)
Tel. +420 224 964 212, E-Mail email@example.com
Background/Aims: Pregnancy-associated plasma protein A (PAPP-A) is a biomarker related to vascular damage. The aim of the study was to focus on PAPP-A and related parameters and their relationship to the prognosis of long-term hemodialysis (HD) patients. Methods: This is a prospective observational cohort study which included 261 long-term HD patients followed up for 5 years and 66 healthy subjects. PAPP-A, placental growth factor (PlGF), matrix metalloproteinase 2 and 9 (MMP-2, MMP-9), insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein-4 (IGFBP-4), and cardiac, nutritional and inflammatory parameters were measured at the beginning of the study and tested as predictors of mortality. Results: PAPP-A, PlGF, IGF-1, IGFBP-4 and MMP-2 were significantly increased in HD patients compared to controls (PAPP-A 27.6 ± 15.5 mIU/l in HD vs. 9.4 ± 2.5 mIU/l in controls, p < 0.001). Increased PAPP-A was a significant independent predictor of overall mortality and mortality due to infection in the multivariate Cox analysis [HR (95% CI): 1.237 (1.060–1.444), p = 0.007, and 1.416 (1.115–1.798), p = 0.004, per standard deviation, respectively]. PAPP-A was not related to cardiovascular mortality. Conclusion: Increased PAPP-A is a significant independent predictor of overall mortality and mortality due to infection but it was not related to cardiovascular mortality in this study.
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