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Pregnancy-associated plasma protein A and mortality in hemodialysis
Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.ORCID iD: 0000-0002-6933-4637
2018 (English)In: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 48, no 8, article id e12959Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Elevated pregnancy-associated plasma protein A (PAPP-A) levels are associated with increased risk of death in ischemic heart disease as well as in hemodialysis patients. Previous research indicates that the prognostic value of PAPP-A may be stronger in patients with concomitant diabetes mellitus or signs of inflammation. We studied the association between PAPP-A and outcomes in prevalent hemodialysis patients and hypothesized that diabetes mellitus and inflammation status act as effect modifiers.

MATERIALS AND METHODS: Circulating PAPP-A levels were quantified using ELISA. Cox proportional hazards- and quantile regression models were used for associations between PAPP-A and mortality. PAPP-A levels were log-transformed for Normality.

RESULTS: During 60 months follow-up, 37 (40%) of the 92 participants died. Higher PAPP-A was associated with increased risk of mortality in unadjusted analysis (HR per SD = 1.4, 95% CI = 1 - 1.9, p = 0.03) and when adjusted for confounders and cardiovascular risk factors (HR = 1.8, 95% CI = 1.18-2.73, p = 0.006). An interaction between PAPP-A levels and diabetes mellitus on mortality was found (HR for the multiplicative interaction term = 2.74 95% CI = 1.02-7.37, p = 0.05). In a quantile regression adjusted for age and sex, one SD increase of PAPP-A was associated with 22 months shorter estimated time until 25% of the patients died (95% CI -35 to -9.1 months).

CONCLUSIONS: Increased PAPP-A levels are associated with higher all-cause mortality in prevalent hemodialysis patients with concomitant diabetes mellitus. 

Place, publisher, year, edition, pages
2018. Vol. 48, no 8, article id e12959
Keywords [en]
Pregnancy-associated plasma protein A, cardiovascular disease, hemodialysis
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
URN: urn:nbn:se:du-27767DOI: 10.1111/eci.12959ISI: 000439927600003PubMedID: 29802620OAI: oai:DiVA.org:du-27767DiVA, id: diva2:1213729
Available from: 2018-06-05 Created: 2018-06-05 Last updated: 2018-08-09Bibliographically approved

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Rudholm Feldreich, TobiasÄrnlöv, Johan

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