OBJECTIVE: Pregnancy-associated plasma protein A (PAPP-A) has prognostic impact in pregnancy and acute coronary syndrome. Patients with chronic kidney disease have an excessive cardiovascular risk. In an effort to identify novel risk factors for cardiovascular disease, we investigated the relationship of PAPP-A with specific outcomes in diabetic patients undergoing dialysis. METHODS: PAPP-A was measured in 1098 diabetic hemodialysis patients, who participated in the German Diabetes and Dialysis Study and followed-up for a median of 4 years. By Cox regression analysis, we assessed the association of baseline levels of PAPP-A with all-cause mortality, combined cardiovascular events and the specific outcomes of sudden death, stroke, myocardial infarction and infectious mortality. RESULTS: Patients had a mean age of 66 ± 8 years (54% male) and median PAPP-A concentration of 17 mIU/L (IQR 13.4-20.9 mIU/L). Per standard deviation increase in PAPP-A the adjusted risk of sudden cardiac death increased by 23% (HR 1.23, 95%CI 1.12-1.36). Categorical analyses showed that the patients in the 4(th) PAPP-A quartile had an adjusted 2.6 fold increased risk of sudden death and 2.8 fold increased risk of stroke as compared to the patients in the 1st quartile. Similarly, the risk of combined cardiovascular events was significantly elevated by the factor 1.5 in patients of the 4(th) quartile. Additionally, PAPP-A levels were associated with infectious deaths and all-cause mortality. CONCLUSIONS: PAPP-A is associated with sudden death, stroke and infectious complications in diabetic dialysis patients. PAPP-A may be useful for risk assessment and monitoring in populations at high risk of cardiovascular events.
- MeSH
- cévní mozková příhoda epidemiologie MeSH
- chronické selhání ledvin krev epidemiologie terapie MeSH
- diabetické nefropatie krev epidemiologie terapie MeSH
- dialýza ledvin * MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- infarkt myokardu epidemiologie MeSH
- infekce mortalita MeSH
- kardiovaskulární nemoci epidemiologie MeSH
- komorbidita MeSH
- komplikace diabetu epidemiologie MeSH
- kouření epidemiologie MeSH
- kyseliny heptylové terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- lipidy krev MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mortalita MeSH
- náhlá srdeční smrt epidemiologie MeSH
- následné studie MeSH
- příčina smrti MeSH
- prognóza MeSH
- proporcionální rizikové modely MeSH
- prospektivní studie MeSH
- pyrroly terapeutické užití MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statiny terapeutické užití MeSH
- těhotenský plazmatický protein A analýza MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Německo MeSH
