title: Effect of hemodiafiltration on pregnancy-associated plasma protein A (PAPP-A) and related parameters.
abstract: BACKGROUND
  Dialysis patients are at high risk of vascular/cardiovascular complications with multifactorial pathogenesis, and pregnancy-associated plasma protein A (PAPP-A) is one of the new markers related to cardiovascular risk. Because hemodiafiltration (HDF) is supposed to be better for cardiovascular status, the aim of this study was to describe whether it has any advantage concerning changes of PAPP-A and related molecules during the session in comparison with hemodialysis (HD).
  
  
  METHODS
  The studied group consisted of 20 chronic hemodialysis patients. In each patient, PAPP-A and related parameters-IGFBP-4 (insulin like growth factor binding protein), IGF-I (insulin like growth factor), and two MMPs (matrix metalloproteinases)-2 and 9-were determined both during a single online HDF session (high-flux polysulfone membrane HF80, postdilution) and during a single HD session (low-flux polysulfone membrane F6, F7) at time 0 (start), 15 min, 120 min, and 240 min (end) of the session.
  
  
  RESULTS
  PAPP-A, elevated at baseline in dialysis patients, changes significantly both during HDF and HD without significant differences between these two procedures (mean levels during HDF were 24.3, 53.9, 24.3, and 27.3 mIU/L). It increases more than two-fold from 0 to 15 min of the session (p < 0.001) and then decreases until the end of the session (p < 0.001). MMP-2 decreased slightly during both sessions (p < 0.001), and changes of other molecules were only minimal.
  
  
  CONCLUSIONS
  A single HDF session compared to HD has no advantage in the decrease of PAPP-A and other tested molecules, all of them related to cardiovascular risk. Studies aimed at a long-term effect of both procedures on these parameters would be needed to further evaluate these therapeutical strategies.
authors.affiliation: Institute of Clinical Chemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital, Karlovo nám. 32, 121 11 Prague 2, Czech Republic. kalousova@seznam.cz
authors.forename: Marta
authors.initials: M
authors.lastname: Kalousová
authors.forename: Magdaléna
authors.initials: M
authors.lastname: Hodková
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dusilová-Sulková
authors.forename: Jana
authors.initials: J
authors.lastname: Uhrová
authors.forename: Vladimír
authors.initials: V
authors.lastname: Tesar
authors.forename: Tomás
authors.initials: T
authors.lastname: Zima
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015200:Fluoroimmunoassay; D017583:Hemodiafiltration / Q000009:adverse effects; D006801:Humans; D018974:Insulin-Like Growth Factor Binding Protein 4 / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000097:blood*; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D011247:Pregnancy; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D006435:Renal Dialysis / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018974:Insulin-Like Growth Factor Binding Protein 4; D007334:Insulin-Like Growth Factor I; D011266:Pregnancy-Associated Plasma Protein-A; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9