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Pregnancy‐associated plasma protein A and mortality in haemodialysis
Author(s) -
Nilsson Erik,
Rudholm Tobias,
Stenvinkel Peter,
Ärnlöv Johan
Publication year - 2018
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12959
Subject(s) - medicine , diabetes mellitus , pregnancy associated plasma protein a , proportional hazards model , confounding , concomitant , pregnancy , endocrinology , gestation , biology , first trimester , genetics
Background Elevated pregnancy‐associated plasma protein A (PAPP‐A) levels are associated with increased risk of death in ischaemic heart disease as well as in haemodialysis 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 haemodialysis 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‐month 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 = .03) and when adjusted for confounders and cardiovascular risk factors (HR = 1.8, 95% CI = 1.18‐2.73, P = .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 = .05). In a quantile regression adjusted for age and sex, one SD increase in 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 haemodialysis patients with concomitant diabetes mellitus.